L3 ANTICOAG THERAPIES

Question 1

why do patients get thromboembolism

triad

Answer 1

Endothelial injury – normal cause for arterial thrombus – damage to lining causing platelets to clot
Blood stasis – venous thromboembolism – bed rest cause this or logn haul flights and blood clots and if abnormal blood flow such as in AF as flow not smooth risk of blood clot
Hypercoagulability – inherited disease , thrombophilia’s or malignancy and trauma

Question 2

4 steps of haemostasis

Answer 2

formation fo paletot plug - adhésion, aggregation, activation and secretion and thrombin

propagation of clotting - clotting cascade

termination of clotting - anti-thrombotic state

fibrinolysis and clot removal - activation of plasmin and lysis of clot and production of d-dimer and FDPs

Question 3

thrombin activates what to form cross linked clot

and what other factors does it amplify

Answer 3

fibrinogen to fibrin and factor 13

also activates factor 11,8 and 5

Question 4

what converts plasminogen to plasmin

Answer 4

tissue plasminogen activator

Question 5

plasmin coverts the cross linked fibrin clot to

Answer 5

D dimer

fibrinogen degradation products ( FDPs)

Question 6

what is dalteparin

Answer 6

heparin

Question 7

prevention of a stroke with someone wit AF

Answer 7

DOAC more common fro AF or warfarin

mechanical heart valves - warfarin

Question 8

what anticoagulant for VTE prophylaxis

Answer 8

lose dose LMWH

Question 9

side effects of anticoagulants

Answer 9

bleeding

major GI bleeds

Question 10

what score can you use for bleeding risk

Answer 10

HAS-BLED score

uncontrolled HTN and previous major bleeding

Question 11

what score do you use for DVT and PE risk

Answer 11

WELLS score

Question 12

what score for anticoagulant use in AF or stroke risk

Answer 12

CHA2DS2VASc

Question 13

DOACs
Axpixaban, Rivaroxaban, edoxaban/dabigatran
Most people started on these not warfarin as they don’t interact with many drugs
Advanatges
- Fewerinteractions
- 6 monthly blood tests for renal fucntions
- Simpleer or patietns and doctors to prescribe
Disadvanatges
- No easy way to reverse them
- Less long term data on efficacy and safety

what do they all - what factors do they bind to

Answer 13

Rivaroxaban and apixaban bind directly 10a to directly inhibt it stopping it from activating prothrombin to thrombin

Dabigatran binds to thrombin itself stopping it having that amplicficaiton effect on coagulation cascade

Question 14

common side effect of dabigatran

Answer 14

dyspepsia - common side effect ( and hepatobillairy disease)

Question 15

what do heparins do

Answer 15

bind to anti-thrombin therefore increasing the inhibition of thrombin

Question 16

how is LMWH given

Answer 16

subcutaneous

Question 17

how Is unfractioned heparin given

Answer 17

IV

Question 18

side effects of heparin

Answer 18

bleeding 
heparin induced thrombocytopenia 
hypokalaemia 
osteoporosis 
accumulate in renal failure

Question 19

what anticoagulant teratogenic in preg

Answer 19

warfarin - inhibits action of vit k

Question 20

warfarin interacts with what

Answer 20

antibiotics, 
analgesics 
anticoagualtns 
anticonvulsants
antidepreessants 
anti-platelet drugs

Question 21

reversal of warfarin what do you do

Answer 21

vit k slow effet

prothrombin complex concentrates - octaplex

Question 22

what instance anticoag is required what do you give

Answer 22

heparin - one of the 3

Question 23

when slower anticoag required what do you give

Answer 23

warfarin and DOACs

Question 24

during pregnancy you give LMWH and then what

Answer 24

warfarin after pregnancy

Question 25

examples of antiplatelts

Answer 25

Antiplatelet – clopidogrel , aspirin and dipyridamole

Question 26

examples of thrombolytics

Answer 26

tissue plasminogen activator

Question 27

67 women with AF 
PMH OF HTN, T2D 
DH: RMAPRIPIL AND METFORMIN AND NKDA 
Cha2ds2-vasc score is 4 and has-bled score 1 
What anticoagulant drug

Answer 27

Rivaroxaban – no bleeding history and ease of dosing regime and check renal function first

Question 28

ECG shows ST elevation in anteroseptal leads
STEMI
Caused by occlusion of coronary arteries – warning of angina due to arthrosclerosis

Answer 28

antiplatelts used morein arterial disease

Question 29

hip replacement - and saddle embolus in Pulmonary artery

Answer 29

need urgent thrombolytic

Question 30

when to use DOAC

Answer 30

DVT , PE , AF

Question 31

when to use heparin

Answer 31

DVT, PE , VTE prophylaxis , haemodialsysi vascular sugeries

Question 32

when to use warfarin

Answer 32

DVT, PE ,AF< mechanical prostetheic heart valves

Question 33

to monitor DOAC use check the renal function twice a year

INR for warfarin

what for heparin

Answer 33

APTTR if infusing

Question 34

reversal for heparins

Answer 34

protamine sulphate