More Block 1 Flashcards
HIT Type I vs II
Occurs 4-10 days after heparin exposure
Type II
HIT Type I vs II
PLT count normalizes w/ continued heparin
Type I
HIT Type I vs II
Major concerns for thrombotic complications
Type II
HIT Type I vs II
Occurs within first 2 days of heparin exposure
Type I
HIT Type I vs II
Non immune
Type I
HIT Type I vs II
Has HIT antibodies
Type II
LMWH vs UFH
Which has a higher chance of HIT?
UFH
How is the Fc receptor complex with heparin made? Whats the issue?
Platelet with PF4 combines with heparin to form heparin with PF4 cytokines
IgG combines with that complex and attaches to the platelet
More PF4 = more platelets
More thrombin = thrombosis occurs
What is the 4 T’s score?
Initial screen for suspicion of HIT
Thrombocytopenia
Timing
Thrombosis
Other causes of thrombocytopenia
Timing info for 4 T score
Days 5 - 10 or under 1 day if heparin used in past 30 days
Days >10 or under 1 day if heparin used within 30-100 days
Day <4 with no recent heparin use
Thrombocytopenia info for 4 T score
> 50% fall or nadir ≥20
30-50% fall or nadir 10019
<30% fall or nadir <10
4Ts score interpretation?
0-3 = low
4-5 = intermediate
≥6 = high
HIT/PF4 vs SRA
Which one is the gold standard for HIT diagnosis?
SRA
HIT/PF4 vs SRA
Which one is quicker to use and therefore has just moderate specificity?
HIT/PF4
HIT/PF4 vs SRA
Which one is typically used first?
HIT/PF4
What do you do if 4T comes back at ≥4?
d/c heparin and start non-heparin anticoagulant
Obtain immunoassay
What are the direct thrombin inhibitors?
Argatroban and Bivalirudin
Argatroban vs Bivalirudin
Which one is an arginine derivative?
Argatroban
Argatroban vs Bivalirudin
Which one is reversible?
Both
Argatroban vs Bivalirudin
Which one has a greater effect on INR?
Argatroban
Argatroban vs Bivalirudin
Which one is a synthetic analog of hirudin?
Bivalirudin
Argatroban vs Bivalirudin
Which one is divalent? Monovalent?
Argatroban - mono
Bivalirudin - divalent
Argatroban vs Bivalirudin
Which one is cleared hepatically?
Argatroban
Argatroban vs Bivalirudin
Which one is dosed regardless if they have renal/liver issues?
Bivalirudin
It’s not CI to use argatroban in liver failure pt, just be careful with dosing (25% or OG dose)
Argatroban vs Bivalirudin
When should aPTT be checked?
Every 4-24 hrs
Argatroban vs Bivalirudin
Which one is dosed at 2mcg/kg/min? Whats the other one’s dose?
Argatroban
Bivalirudin - 0.2mcg/kg/min
Argatroban vs Bivalirudin
Which one will show falsely elevated INR when bridging to warfarin?
Argatroban
Argatroban vs Bivalirudin
Which one is metabolized in plasma?
Bivalirudin
When transitioning to oral therapy from argatroban/bivalirudin, what can be considered?
DOACs or warfarin (only if PLTs are >150k)
If transitioning to warfarin from argatroban/bivalirudin, what must they meet?
PLT >150k
Overlap with DTI or fondaparinux
Continue for 4wks (no thrombosis) or 3 months (with thrombosis)
Base excess interpretatio?
2 = base excess of 2 more than normal = alkalotic
-5 = base deficit of 5 = acidotic
Normal pCO2 level?
40
Normal pO2 level?
80-100
Normal base excess level?
-2 to +2
Values for respiratory alkalosis/acidosis?
<40 pCO2 = respiratory acidosis
> 40 pCO2 = respiratory acidosis
Values for metabolic alkalosis/acidosis?
> 28 HCO3 = metabolic alkalosis
<22 HCO3 = metabolic acidosis