Hemostasis Flashcards
What is the difference between the Primary and Secondary phases in Hemostasis?
Primary
- Vascular phase = immediate response
- Platelet phase = 1-2 seconds
Secondary
- Coagulation phase = 10-20 seconds
- Fibrin formation = 1-3 minutes
What platlet count defines Thrombocytopenia?
< 150,000 MicroL
What are some Acquired Quantitative Platelet Disorders?
- Liver Disease
- Bone Marroe Disease
- Alcohoic Suppression of Marrow
- Medications
- Idiopathic
What is an Inherited Disease that is both Quantitative and Qualitative in regards to Platelet Disorders?
Von Willebrands Disease
What is Von Willderand’s Disease?
- Most commone inherited bleeding disorder
- Autosomal dominant; 1:1000 people
- Qualitative or Quantitative defect of vWF
What are the 3 tyeps of Von Willebrand’s Disease?
- Most common; quantitative, 70-80%
- Has subyptes; qualitative
- Most Severe; quantitative, < 5%
Define Bleeding Time…
What is aPTT (Active Partial Thromboplastin Time)?
How is it different than PT?
Describe the clotting cascade…
How do you treat Von Willdebrand’s Disease?
- DDAVP (Desmopressin Acetate)
- Cryo Therapy
- Factor VIII
What is PFA?
What is a CBC?
Packed Cell Volume…% of whole blood that are RBCs…
What is a normal platelet count?
150,000 - 400,000/ml
What are 3 Inherited Coagulation Disorders?
- Hemophilia A - Factor VIII
- Hemophilia B - Factor IX
- Hemophilia C - Factor XI
What are 2 Acquired Coagulation Disorders?
- Liver Disease
- Vit K Deficiency
What are 7 drugs that cause therapeutic anticoagulation?
- Coumadin
- Pradaxa
- Eliquis
- Xarelto
- Heparin
- Levenox
- Arixtra
What is the most common cause of prolonged bleeding?
Acquired Coagulation Disorders
What are some indications for Therapeutic Anticoagulation?
- Mechanical heart valves
- Atrial fibrillation
- Hx of thromboembolic stroke, TIA
- Hx of deep venous thrombosis
- Hx of pulmonary embolism
Describe Coumadin…
- Half life - 2.5 days
- Taken PO
- Inhibits Vit K
- Inhibits Factors: II, VII, IX, X
Describe Heparin…
- Half life - 60-90 minutes
- Given IV
- Inhibits the Intrinsic Pathway
Describe Lovenox…
- Half life - 4-7 hours
- Given SQ (Sub-Cutaneous Injection)
- Inhibits Intrinsic Pathway
Describe Lepirudin…
- Half life - 1-2 hours
- Given IV
- Direct Thrombin Inhibitor
Describe Arixtra…
- Half life - 17-21 hours
- Given SQ (Sub-Cutaneous)
- Direct Thrombin Inhibitor
Describe Pradaxa…
- Half life - 12-17 hours
- Given PO
- Direct Thrombin Inhibitor
Describe Xarelto/Eliquis…
- Half life - 8-15 hours
- Given PO
- Activated F 10 inhibitor
What is the average PT?
- Prothrombin Time
- 10-12 seconds
What is the average aPTT?
- Activated Partial Thromboplastin Time
- 25-30 seconds
Describe the critical role of fibrin…
What is INR?
What are normal values of INR?
What are some ways you can medically manage a patient with bleeding disorders regarding Blood or Blood Products?
- FFP (Fresh Frozen Plasma) - Coagulation Factors
- Factor VIII
- Cryoprecipitate - Factors: 1, 5, 8, vWF
What vitamin is critical in medical management of coagulation chalenged patients?
Vitamin K
Where do you manage a pt on Heparin?
In patient
Where can you manage a patient on Lovenox?
Out patient
Describe different dental procedures you can do in respect to low/high INR ranges…
When is Post-Op Hemorrage reported for Coumadin under what INR ranges?
- 4.4% (7 cases of 162)
- INR 1.5 - 1.99 - 2 cases of 80
- INR 2.0 - 2.49 - 5 cases of 50
- INR 2.5 - 2.99 - 0 cases of 27
- INR > 3.0 - 0 cases of 5
What are 3 things a dentist can do to achieve hemostasis?
- Presure
- Excellent Surgical Technique
- Primary Closure if Possible
What are 5 chemo therapeutic agents you can use to help achieve hemostasis?
- Microfibrillar Collagen
- Gelfoam
- CollaPlug
- Surgicel
- Topical Thrombin
What is Microfibrillar Collagen?
What is Gelfoam?
What is CollaPlug?
What is Surgicel?
What is Topical Thrombin?
What is plasminogen?
The inactive precursor of the enzyme plasmin present in blood
Describe Fribrinolysis…
What are 2 drugs that counteract Fibrinolysis?
- Transexamic Acid
- Amicar (episilon aminocaproic acid)
If you order a CBC, what values can you expect to see?
What is a CHEM 7 Lab Test?
This test can be used to evaluate kidney function, blood acid/base balance, and your levels of blood sugar, and electrolytes. Depending on which lab you use, a basic metabolic panel may also check your levels of calcium and a protein called albumin.
If you order a COAGS lab test, what are you ordering?
