Hemostatis agent Flashcards
What is Tisseel
Topical sealant containing fibrinogen and thrombin (small amount of aprotinin)
What is FLOSEAL?
topical agent that consists of gelatin matrix hemotstatic sealant that is composed of human thrombin and a proprietary gelatin matrix.
Augment the coagulation cascade at multiple site. It has proven efficiacy in cardiac surgery.
Best to use with arterial bleeding
What is COSEAL?
Surgical sealant composed of polyethylene gycol (PEGS)
What is surgicel?
oxidized cellulose
provides a platform for hemostasis to occur
What is dose of protamine for reversal of heparin?
1 gram of protamine per 100 units of heprain
What is the range of dosing for factor VII
According to body weight
65ug/Kg to 100ug/k–NovoSeven is available in the hospital at 1.2, 2.4, and 5 mg Vials.
How does factor VII work
stimulates the coagulation cascade by activation of thrombin at the site of tissue injury by tissue factor-dependent and independent mechanisms.
Tissue-factor dependent mechanism results in production of FactorX which leads to the generation of thrombin.
The tissue factor independent mechanisms include activation, aggregation, recuitment and stablization of platelets that are resistant to fibrinolysis.
What is BioGlue
Has two components—purified bovine serum albumin (BSA) and glutaraldehyde.
polymerize reaction in 20 to 30 seconds and reaches full strength in 2 minutes
Name 2 new anitplatelet durgs
Prasugrel
ticagrelor
Cangrelor
What study and dosing is important regarding ASA and bypass grafts
Antiplatelet trialists Collaboration
restarting ASA before surgery or withing 24 hours after surgery had a similar benefit on vein graft patency.
75 to 325 mg.
Effect of ASA on mortality
Study from mayo clinic in 16 3 patients showed preoperative asa pts had a significantly lower post operative mortality (1.7% vs 4.4). No difference in bleeding.
NEJM study showed that preoperative ASA in isoalted CABG patients resulted in 27% reduction in-hospital mortality.
Name 3 thienopyridines
prodrugs that are biotransformed into molecules that bind irrecversible to P2Y12 receptor.
Ticlopidine
Clopodigrel
prasugrel
Why plavix in pts with ACS
CURE: clopidogrel in Unstable ANgina to precent recurrent events—ASA + plavix
This resulted in a reduced cardiovascular death, myocardial infarction, or stroke in patients with ACS
11% relative risk reduction.
benefit was mainly before surgery.
What is Prasugrel
Associated with increased bleeding risk
surgery should be delayed by 7 days.
similar active metabolite to plavix
What is Ticagrelor
Nonthienopyridine, pyrimidine derivative, direct-acting, and reversible antagonis of the ADP receptor P2Y12 with a plasma half-life of about 12 hours
More rapid, potent and consistent effect on platelet function compared with clopidogreal.
Currently indicated for the treatment of patients with ACS on the basis of the PLATO trial.
What is PLATO trial
Large, multicenter trial, with pts in ACS with/without ST MI.
Composite of death, MI, stroke, at 12 months was signficant reduced with ticagrelor compared to clopidogrel. 4.5% vs 5.9%
According to recent recommendations of the 2011 ESC guidelines for NSTEM with ACS
Ticagrelor is considered first line therapy.
Prasugrel is recommended only for P2Y12 inhibitor naive patients whom coronary antomy is known and are who are proceeding with PCI
Plavix is for pts who cannot receive ticagrelor or prasugrel.
How long should you stop ticagrelor
5 days before surgery
ticagrelor higher potency; platelet inhibition is the same as plavix in first 24 to 28 hour
only 3 to 5 days from discontinuation is there less platlete inhibiton compared to plavix.
What is the evidence for GPIIbIIIa
Abciximab
Eptifibatide
tirofiban
PURSUIT study in patients with NSTEMI and ACS
30 day mortality was 26.1% vs 30.8%
When do you stop Eptifibatide and tirofiban before cardiac surgery
2 to 4 hours