Hemostatic drugs and fibrinolytics

Question 1

T/F: Platelet transfusion works best for irreversible inhibitors

Answer 1

True

Question 2

Desmopressin (DDAVP)

Answer 2

MOA: triggers release of VWF and causes platelet activation, cross-linking, and prolongs t1/2 of factor VIII
Indications: VWF deficiency (von willebrands disease), factor VIII deficiency (hemophilia A), platelet dysfunction (uremia)

Question 3

What different clotting factors can be used to treat clotting factor diseases?

Answer 3

Factor VII= hemophilia A
Factor VIII= hemophilia A
Factor IX= hemophilia B

Question 4

T/F: In cirrhosis we use PCC because all clotting factors needs to be depleted

Answer 4

False, we would use Cryo or FFP

Question 5

What are approaches for anticoagulant reversal?

Answer 5

You can either overwhelm the anticoagulant with PCC or neutralize it

Question 6

T/F: Dabigatran reversing can be treated with PCC

Answer 6

False, this drug is least reversible by PCC and we need to use idarucizumab instead

Question 7

Idarucizumab

Answer 7

MOA: monoclonal antibody that binds and inactivates dabigatran
Indications: reverses anticoag effect of dabigatran only

Question 8

Andexanet alfa

Answer 8

MOA: recombinant factor that binds and inactivates factor Xa inhibitors
Indications: reverses anticaog effect of factor Xa inhibitors
Duration of action: 4 hours (short)
Clotting after use is 10% (more effective at reversal)

Question 9

Protamine

Answer 9

MOA: weak anticoag effect on its own (inhibits thrombin) but chemically neutralizes heparin (greater acting in UFH) by binding together (positive and negative charge) so that ATIII cannot be activated anymore
Indications: reversal of heparin

Question 10

Ciraparantag

Answer 10

MOA: synthetic molecule capable of H bonding and binds + inactivates heparin along with factor Xa & IIa inhibitors
Indications: reverses a lot of dif anticoags
Downside: not FDA approved

Question 11

Which two targets can we use in reversal of warfarin?

Answer 11

PCC or FFP

Question 12

Phytonadione (vitamin K)

Answer 12

MOA: allows synthesis of clotting factors depleted in warfarin and restores vit K (increases)
Indications: restores vitamin K levels and is given after PCC

Question 13

Anti-fibrinolytics (aminocaproic acid and tranexamic acid)

Answer 13

MOA: competitive inhibitor of plasminogen and plasmin; stabilizes clots in all patients even if not taking an anticoagulant
Clinical use: control of bleeding from various causes and can be given in many dif formulations

Question 14

Which hemostatic agents are topical?

Answer 14

Tranexamic acid, aminocaproic acid, and thrombin

Question 15

T/F: when plasmin is activated it increases fibrin levels

Answer 15

False, when plasmin is activated it causes fibrin to be degraded

Question 16

Alteplase

Answer 16

MOA: acts as a fibrinolytic by acting on t-PA to stimulate plasmin which can act in decreasing clotting
Formulation: IV and requires extended infusions

Question 17

Tenecteplase

Answer 17

MOA: acts as a fibrinolytic by acting on t-PA to stimulate plasmin which can act in decreasing clotting
Formulation: dosed as a single IV bolus