Module 2 Exam 1 lecture 5

Question 1

VTEs are formed where?

Answer 1

In areas of slow distributed flow

Question 2

T/F stasis blood promotes thrombus

Answer 2

true

Question 3

what are venous thrombi composed of?

Answer 3

RBC, Fibrin and platelets

Question 4

how do symptoms of VTE occur?

Answer 4

Flow is obstructed
vascular tissue becomes inflamed
thrombus occurs and affects venous blood flow
Emboli occur and enter pulmonary circulation

Question 5

Do all DVTs lead to PEs? Do all PEs come from DVTs?

Answer 5

Not all DVTs lead to PEs, but all PEs come from DVTs

Question 6

What is the virchous triad

Answer 6

3 main things that could cintribute to blood clot development

Question 7

Name the virchous triad

Answer 7

1. Hypercoagulable state- pregnancy, cancer
2. Endothelial injury- abnormalities of surface of contact with blood
3. Circulatory stasis- abnormalities in blood flow (long periods of immobility)

Question 8

pathway for the development of VTE

Answer 8

Vessel wall injury (exposure of endothelium)
This triggers platelet adhesion and aggregation
and coagulation cascade is activated
This produces thrombin, triggering fibrin formation

Question 9

What activates degradation of clot

Answer 9

Tissue plasminogen activator (TPA)

Question 10

Which factors are procoagulant

Answer 10

VWF, Factor Xa, Factor II (thrombin), factor XIIIa, TF, XIIa

Question 11

Which factors are anticoag

Answer 11

Heparin, antithrombin, proteins C and S, thrombomodulin

Question 12

3 phases of coagulation cascade?

Answer 12

Initiation phase
Amplification phase
propagation phase

Question 13

How is the initiation phase started?

Answer 13

Tissue factor bearing cell is exposed to BV after injury

Question 14

How is amplification phase started?

Answer 14

BV damage leads to trace amounts of THROMBIN, leading to amplification phase

Question 15

What is the amplification phase?

Answer 15

Clotting factors become activated developing fibrin clot.

Question 16

What is the propagation phase? key part in propagation phase?

Answer 16

Propagation phase leads to development of fibrin clot. A key part is the development of large amounts of thrombin

Question 17

How is fibrinogen turned into fibrin

Answer 17

By thrombin

Question 18

prothrombin and thrombin othe rnames

Answer 18

Prothrombin-factor 2
thrombin-factor 2a

Question 19

rivaroxaban is what type of drug

Answer 19

factor Xa inhibitor

Question 20

Argatroban is what type of drug

Answer 20

DTI

Question 21

Name NOAC/DOAC drugs

Answer 21

DTI- Dabigatran
Factor Xa inhibitors-
rivaroxaban
apixaban
Edoxaban

Question 22

Which NOAC/DOAC is only used for hip surgery

Answer 22

Dabigatran

Question 23

Which NOAC/DOAC is approved for Knee and hip surgery

Answer 23

Rivaroxaban/apixaban

Question 24

Which NOAC/DOAC uses renal adjustments in Scr not CRCL

Answer 24

Apixaban

Question 25

Which NOAC/DOAC is the only one that needs dosage adjustments for older/frail patients

Answer 25

apixaban

Question 26

Which NOAC/DOAC is not used if a patients CrCL is above 95

Answer 26

edoxaban

Question 27

WHen dosing Dabigatran and edoxaban, how is it different from dosing rivaroxaban and apixaban

Answer 27

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

Question 28

T/F we can use rivaroxaban/apixaban after the 6 months regardless of what drug pt was on 0-6 months

Answer 28

True

Question 29

How is warfarin given?

Answer 29

UFH/LMWH/fondaparinux 5 days, overlap with warfarin AND INR >2

Question 30

When should we use UFH with warfarin?

Answer 30

When CRCL<30

Question 31

What is INR? What is a normal INR?

Answer 31

INR is a number that represents how long it takes for blood to clot. Normal INR =1
hugher number =higher bleeding risk

Question 32

counseling factors about warfarin

Answer 32

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