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IHO Week 6 > Nikcevich- Clincal Cases in Coagulation > Flashcards

Nikcevich- Clincal Cases in Coagulation Flashcards

1
Q

What is a normal platelet count?

A

150-400,000

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2
Q

What happens if the platelet count is 25,000

A

Probably nothing

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3
Q

What happens if the platelet count is <10,000

A

Increased risk of mucocuntaneous bleeding and CNS hemorrhage

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4
Q

What is more important in regards to platelets than the actual number of platelets?

A

Platelet surface area

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5
Q

What is the most common reason for impaired platelet function?

A

Aspirin

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6
Q

INR is used to usually monitor what drug?

A

Warfarin efficacy

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7
Q

What is the target INR?

A

2-3.5

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8
Q

What does PTT measure?

A

heparin efficacy

NOT LMW heparin

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9
Q

What is the single worse clinical test available?

A

Bleeding time

was designed to measure platelet function

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10
Q

What is the most common cause of increased bleeding time?

A

Aspirin

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11
Q

What does Aspirin do?

A

Irreversibly acetylates platelets

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12
Q

How long does aspirin’s effects last for?

A

Up to 10 days

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13
Q

How do you reverse aspirin?

A

Wait 10 days and see if you can give platelets

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14
Q

What do ibuprofen, naproxen, etorolac, sulindac and indomethacin do?

A

Reversibly effect platelet function

**effects can be reversed w/in 6-8 hrs

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15
Q

What is the most common anti-coagulant?

A

Warfarin

Interferes w/ vit K dep secondary glycosylation of factors 2,7,9,10

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16
Q

How is warfarin dosed?

A

Accodring to INR

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17
Q

What is the biggest disadvantage of Warfarin?

A

It has a lot of drug interactions

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18
Q

How do you reverse warfarin?

A

Time
vit K
Fresh frozen plasma

19
Q

What type of heparin has the most reliable absorption?

A

LMWH- no need to monitor levels

Unfractionated has UNPREDICTABLE absorption–need to monitor daily w/ PTT

20
Q

When is clopidogrel used?

A

After cardiac stents/ stroke

21
Q

What does tPA do? When is it used?

A

Responsible for direct fibrinolysis.

MI, stroke, PE

22
Q

What does vit K do?

A

Reverses effects of warfarin

often helpful w/ coagulopathy of liver disease

(phytadione)

23
Q

What does DDAVP do?

A

Increases vWF prodcution

24
Q

What does fresh frozen plasma do?

A

Gets all coagulant factors to normal levels

can reverse warfarin effects/replace factors missing d/t liver disease/DIC

25
Q

What does cryprecipitate do?

A

Provides fibrinogen, VWF, facotr 8 and 13, fibronectin

26
Q

What is commonly sen w/ platelet defects?

A

Prolonged bleeding
petechiae and easy bruising
skin and mucous membranes
non-recurrent bleeding

27
Q

What is seen w/ coagulation defects?

A

pro-longed bleeding
deep hematomas
recurrent bleeding

28
Q

What do you think when you see an elevated PTT?

A

Heparin?
Lupus-anticoagulant or antiphospholipid Ab?
Liver disease

29
Q

How do you diagnose a problem from a prolonged PTT?

A

Do a mixing study

corrects- lab error, heparin contamination

don’t correct- LAC or inhibitor

30
Q

What are causes of prolonged INR?

A

Warfarin use- most common
anti-phospholipid ab
liver disease
malnutrition (vit K def)

31
Q

How do you determine the cause of prolonged INR?

A

Mixing study

corrects– lab error/factor def
doesn’t correct– anti-phospholipid ab or inhibitor

32
Q

What can cause thrombocytosis?

A

Increased platelets can be caused by secondary processes like IDA

or primary processes like a myeloproliferative disorder

33
Q

How long should a pt w/ uncomplicated non-life-threatening DVT/PE be given Warfarin?

A

At least 6 months of warfarin w/ target INR 2-3

34
Q

How long should you treat someone with life-threatening DVT/PE/arterial thrombosis?

A

indefinite anticoagulation

35
Q

How long should you treat a second DVT/PE that isn’t life threatnening?

A

Indefinitely

36
Q

How long should you treat an uncomplicated first DVT/PE in someone who is homozygous for an inherited coagulopathy?

A

indefinitely

37
Q

How long should you treat an uncomplicated first DVT/PE in someone who is heterozygous for an inherited coagulopathy

A

At least 6 mos w/ target INR 2-3 or longer

38
Q

What does an IVC filter do?

A

Traps any PE. Most frequently used in preoperative pt w/ increased risk for DVT/PE

Requires anti-coagulation

39
Q

Why do you bridge w/ heparin?

A

Because many pro-coagulant factors have a longer half life than protein C.

Factor III t 1/2 = 60 hrs
F VII= 6 hrs

Protein C t1/2 = 9 hrs

40
Q

What is a surrogate marker for low prot C?

A

HIGH INR

low factor VII

41
Q

A pt who is managed w/ warfarin develops epistaxis and has an INR of 10. What do you order for them?

A

2 mg PO x1 of Vit K

42
Q

How do you treat ITP- immune mediated thrombocytopenia?

A

Prednisone at 1mg/kg daily
Pulse dexamethasone 40 mg po qdx4d

Very common- low platelets

43
Q

How do you treat a pt who has ITP and a platelet count of 65k?

A

Observe w/ serial monitoring

IHO Week 6 (14 decks)

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