Hemostatic Agents Flashcards
What are indications for use of aminocaproic acid?
- treatment of excessive bleeding resulting from hyperfibrinolysis or urinary fibrinolysis
- reduces bleeding and transfusion requirements for patients on cardiopulmonary bypass
- allows for completion of surgery after stopping oozing in patients with cirrhosis
What can occur with rapid IV infusion of aminocaproic acid?
- arrhythmias
- bradycardia
- hypotension
What are adverse effects of amicar?
- CNS: dizziness, headache
- GI: abdominal pain, cramping, diarrhea, N/V
- local effect: pain and necrosis and injection site
- other: fever, malaise, nasal stuffiness, pruritus, rash
- respiratory: dyspnea
What is TXA’s mechanism of action?
- competitive inhibitor of several plasminogen binding sites to reduce plasmin.
What is the indication for use of TXA?
- bleeding prophylaxis for surgery or trauma
What is NovoSeven RT’s mechanism of action?
- works on the extrinsic pathway
- recombinant factor VIIa binds to activated platelet receptors or tissue factor
- which activates factor X and causes generation of thrombin and fibrin
What are indications for treatment with NovoSeven RT?
- congenital factor VII deficiency
- hemophilia A or B
What are complications associated with NovoSeven RT?
- thromboembolic events
- cerebral ischemia or infarction
- myocardial ischemia or infarction
What are off-label uses for NovoSeven RT?
- massive bleeding despite surgical intervention, FFP, Cryo, or >6 units PRBC in 12hrs
- spontaneous intracranial hemorrhage
- warfarin-induced bleeding that cannot wait for reversal with FFP or vitamin K
What is a major disadvantage of NovoSeven RT?
- cost
What are the 3 type of prothrombin complex concentrate?
- FEIBA
- Kcentra
- Profilnine SD
What substances are part of Kcentra?
- factor II
- factor VII
- factor IX
- factor X (inactive)
- contains heparin
What substances are included in FEIBA?
- factor II
- factor VII (active)
- factor IX
- factor X
What is a disadvantage of FEIBA?
- has active factor VII which can increase risk of thrombosis
What 3 substances make up profilnine SD?
- factor II
- factor IX
- factor X
- no heparin
What are indications for use of desmopressin (DDAVP)?
- diabetes insipidus due to inadequate production of ADH by posterior pituitary
- Treatment of vWB disease and factor VIII deficiency
- reduction of intraoperative blood loss and transfusion requirements during cardiac and spinal fusion surgery
What are the side effects of DDAVP?
- hyponatremia
- hypotension/hypertension
- nausea
What is desmopressin’s mechanism of action?
Promotes platelet adhesiveness to the vascular endothelium
DDAVP results in an increased level of factor ___
VIII
vWB
What 3 substances are released from the endothelial wall after DDAVP administration?
- von Willebrand factor
- Tissue-type plasminogen activator
- Prostaglandins
T/F
Amicar is a direct inhibitor of plasmin’s anti-platelet effects.
FALSE
its is a direct inhibitor of plasminogen, which indirectly inhibits plasmin
How is Dextran’s 40 MOA?
- It’s a large glucose molecule, so it pulls water into the blood
- This decreases blood viscosity and risk of clot
T/F
Dextran 40 does not raise glucose levels
True
What are 3 side effects of Dextran 40?
- Allergic reaction (d/t IgG antibodies)
- Increased bleeding due to decreased PLT adhesiveness
- Rouleaux formation (makes cross-matching of blood difficult)
