Procoagulants

Question 0

Vit K1

Answer 0

Phytonadione , Mephyton
Green veggies, clinically relevant form
1-2mg for warfarin OD , Slow IV or anaphylaxis risk
FFP 15ml/kg for hemorrhagic emergency

Question 1

Protamine

Answer 1

Anticoagulant activity by Inhibiting factor V activation
Median half life is 5 min compared to heparin 1-2 hrs, 1:1.3
Slow calculated infusion better than common bolus
Anaphylaxis, extreme hypotension, crash back on CPB
Little no effect on LMWH or Fondaparinux

Question 2

Amicar

Answer 2

Aminocaproic acid , antifibrinolytic
Synthetic lysine, prevents plasminogen activation
Cleared by kidneys
5-10 grams added to prime

Question 3

Tranexamic acid

Answer 3

Cyklokapron , Lysteda
Synthetic lysine, prevents plasminogen activation
Cleared by kidneys
10X more potent than amicar

Question 4

Aprotinin

Answer 4

Trasylol
Serine protease inhibitor II, IXa, Xa, XIa, XIIa
Blocks plasmin. Pulled 2007 b/c AKI, HF, stroke
Should have only been used in high risk, redo, JW

Question 5

Desmopressin

Answer 5

DDAVP , synthetic ADH
Less pressor activity, Endothelial release of VIII and VWF
Nasal spray , not EBM
Hemophilia A and VWD

Question 6

FFP and CRYO

Answer 6

FFP - 20mL/kg raises ATIII by 20%
Anaphylaxis, TRALI
Cryo - 1 unit = 15ml = 300mg fibrinogen
I, VIII, XIII, and VWF