OS - bleeding Flashcards
what are the classification of bleeding problems?
hereditary
acquired
other
what type of medications are associated with bleeding risk?
antiplatelets
NOACs
coumarins
heparins
what is a sign that someone has a coagulant factor deficiency?
stops bleeding early after procedure then develops subsequent bleed
what is a sign someone has platelet abnormalities?
small superficial haemorrhage
what is a sign that someone has clotting factor abnormalities?
deep bleeds
what are the 4 types of bleeding disorders a pt may present with?
- vascular abnormalities
- platelet deficit - number
- platelet deficit - quality/ function
- clotting mechanism
what platelet volume will cause petechial hemorrhage on its own?
50 x 10(9)L
what platelet volume causes petechial haemorrhage and ecchymosis?
20-50 x 10(9)L
what platelet volume causes melaena, haematemesis, and haemturia (bloos in stool, vomit and urine)
<20(9)L
list types of hereditary bleeding disorders?
haemophillia VII + IX
factor XIII
vW disease
Ehlers Danlos (vascular)
list causes of acquired bleeding disorders?
medications
liver disease
alcoholism
haematological malignancy; lymphoma, leukaemia
what diseases do patients taking anticoagulants typically present with?
DVT
PE
cardiac syndromes
AF
MI
CVA - ischaemic stroke
TIA
list the types of anticoagulants?
coumarins
parenteral heparin
LMW heparin
non vit-k (NOACS)
list types of parenteral anticoagulants?
heparin sodium
LMW heparin
Dalteparin sodium
Enoxiparin
Tinzaparin
why are parenteral anticoagulants used?
patients on haemodialysis
what can long term use of herparin lead to?
platelet disorder
name antiplatelets
clopidogrel
aspirin/ NSAIDs
prasugrel
ticagrelor
dipyridamole
what do patients on antiplatelets require for xla?
closer haemostatic intervention
list NOACs?
apixaban
rivaroxaban
edoxaban
dabigatran
how do you manage pts on a NOAC that need xla?
hold back a dose
list vitamin K antagonists
coumarins:
warfarin sodium
acenocoumarol
phenindione
what must be checked prior to xla for patients taking vitamin k antagonists?
INR is less than 4
what are types of spontaneous bleeding?
primary
reactionary
secondary
what is primary bleeding?
intra-operative - soft/hard tissues
prolonged - platelet deficit
what is reactionary bleeding?
2-3 hours post op
when LA wears off
what is secondary bleeding?
up to 14 days
probably due to infection
how is a platelet plug formed?
vasoconstriction
platelet adhesion
activation
aggravation
what is normal bleeding after xla?
2-5 mins
biting pressure aids termination
what is abnormal bleeding after xla?
increase volume, extended duration
what are ways to manage bleeding post xla?
pressure
suture
bone wax
crush
electrocautery
silver nitrate
list types of haemostatic agents?
gelatin
collagen
cellulose based
adhesives
topical thrombin
what is tranexamic acid?
antifibrinolytic
when would you refer a pt in regards to bleeding post op?
ongoing severe haemorrhage
reached the extent of capabilities
decreased BP (100/60)
increased HR >100bpm
fluid loss
what does a haematoma present as?
soft tissue swelling
