Module 2 Exam 1 lecture 5 Flashcards
VTEs are formed where?
In areas of slow distributed flow
T/F stasis blood promotes thrombus
true
what are venous thrombi composed of?
RBC, Fibrin and platelets
how do symptoms of VTE occur?
Flow is obstructed
vascular tissue becomes inflamed
thrombus occurs and affects venous blood flow
Emboli occur and enter pulmonary circulation
Do all DVTs lead to PEs? Do all PEs come from DVTs?
Not all DVTs lead to PEs, but all PEs come from DVTs
What is the virchous triad
3 main things that could cintribute to blood clot development
Name the virchous triad
- Hypercoagulable state- pregnancy, cancer
- Endothelial injury- abnormalities of surface of contact with blood
- Circulatory stasis- abnormalities in blood flow (long periods of immobility)
pathway for the development of VTE
Vessel wall injury (exposure of endothelium)
This triggers platelet adhesion and aggregation
and coagulation cascade is activated
This produces thrombin, triggering fibrin formation
What activates degradation of clot
Tissue plasminogen activator (TPA)
Which factors are procoagulant
VWF, Factor Xa, Factor II (thrombin), factor XIIIa, TF, XIIa
Which factors are anticoag
Heparin, antithrombin, proteins C and S, thrombomodulin
3 phases of coagulation cascade?
Initiation phase
Amplification phase
propagation phase
How is the initiation phase started?
Tissue factor bearing cell is exposed to BV after injury
How is amplification phase started?
BV damage leads to trace amounts of THROMBIN, leading to amplification phase
What is the amplification phase?
Clotting factors become activated developing fibrin clot.
What is the propagation phase? key part in propagation phase?
Propagation phase leads to development of fibrin clot. A key part is the development of large amounts of thrombin
How is fibrinogen turned into fibrin
By thrombin
prothrombin and thrombin othe rnames
Prothrombin-factor 2
thrombin-factor 2a
rivaroxaban is what type of drug
factor Xa inhibitor
Argatroban is what type of drug
DTI
Name NOAC/DOAC drugs
DTI- Dabigatran
Factor Xa inhibitors-
rivaroxaban
apixaban
Edoxaban
Which NOAC/DOAC is only used for hip surgery
Dabigatran
Which NOAC/DOAC is approved for Knee and hip surgery
Rivaroxaban/apixaban
Which NOAC/DOAC uses renal adjustments in Scr not CRCL
Apixaban
Which NOAC/DOAC is the only one that needs dosage adjustments for older/frail patients
apixaban
Which NOAC/DOAC is not used if a patients CrCL is above 95
edoxaban
WHen dosing Dabigatran and edoxaban, how is it different from dosing rivaroxaban and apixaban
Dabigatran and edoxaban require 5-10 days of parenteral injectable anticoagulation then switched to oral
Rivaroxaban and apixaban- Both PO at higher or more frequent doses for 7 days, then lower doses PO for 6 months plus
T/F we can use rivaroxaban/apixaban after the 6 months regardless of what drug pt was on 0-6 months
True
How is warfarin given?
UFH/LMWH/fondaparinux 5 days, overlap with warfarin AND INR >2
When should we use UFH with warfarin?
When CRCL<30
What is INR? What is a normal INR?
INR is a number that represents how long it takes for blood to clot. Normal INR =1
hugher number =higher bleeding risk
counseling factors about warfarin
Drugs- Gs make u bleed (ginseng, garlic, ginko), aspirin and NSAIDs increase bleeding risk
Diseases- any changes in medical condition since last time I saw you?
Doses- any missed doses
Diet- any changes in VIT K intake?
drink- any ETOH consumption
Bruises bleeding
