Prolonged bleeding Flashcards
What are the two classification of bleeding problems
Congenital causes and acquired causes
What congenital causes would cause bleeding problems
haemophiliacs and hereditary coagulation problems
what acquired causes lead to bleeding problems
Antiplatelet medication
What is the purpose of haemostasis
to prevent blood loss
When does the process of haemostasis start
As soon as a vessel is ruptured, damaged or severed
Describe the mechanism for haemostasis
vascular spasm
leads to platelet activation
leads to platelet aggregation and formation of plug as well as blood coagulation through the intrinsic and extrinsic cascade
this leads to production of fibrin plug
The fibrin plug is then surrounded by many fibroblast cells, monocytes, WBCs which turn the blood clot into fibrous scar -permanent scar to seal the
describe the intrinsic pathway
Exposed collagen leads to platelet activation
factor XII activates XI which activated Ix which activated VIII which converts X into Xa
Xa coverts prothrombin to thrombin
thrombin converts fibrinogen to fibrin
describe the extrinsic pathway
Tissue damage leads to activation of factor VII
this converts X to Xa
Xa coverts prothrombin to thrombin
thrombin converts fibrinogen to fibrin
What factors does warfarin act on
IX, VII, X and prothrombin to thrombin
what is warfarin and how does it work
warfarin is an anticoagulant medcation
it works by interfering with vitamin K production
Vitamin K is responsible for factors ii, Vii, iX and X
so warfarin reduces the production of factors ii, Vii, iX and X
so warfarin acts on both intrinsic and extrinsic pathway
how do new oral anticoagulants differ from warfarin
These act on specific points in the pathway by mostly preventing activation of factor X to factor Xa
give three examples of new anticoagulants that work by preventing the activation of factor x to factor Xa
Apixaban
Rivaroxaban
edoxaban
How does the new anti coagulant dabigatran work
acts specifically on the conversion of prothrombin to thrombin
why are the new anti-coagulants beneficial
they target specific points in the pathway so the effects are less variable and we have reliable predictable action and also quick onset
what are the disadvantages of warfarin
takes a long time to start acting and long time to wear off
can be affected by drug interations
can be affected by some foods we eat
what is the purpose of the endothelial layer of the vessel
it prevents the activation of platelet so prevents clotting factors
how does clotting start
vessel wall is broken
collagen fibres are exposed
endothelial walls disappear
this will activate the platelets via the intrinsic and extrinsic mechanism
why is it important to have a pathway that breaksdown clots alongside the pathway that forms a clot
all haemostatic mechanisms need to be balanced so if the body is creating a blood clot we need a pathway to stop clotting from going uncontrolled and getting bigger and travelling around the body causing damage
describe the cloth breakdown pathway
as the clot forms we have prothrombin converting to thrombin
thrombin catalyses plasminogen to plasmin
plasmin breakdown fibrous clots
if a patient attends for an extraction but is on warfarin do we tel the patient to stop their warfarin
No, there is evidence that if you stop warfarin there is a greater risk of causing more harm than good
what dos sdcep guidance say about warfarin and extractions
Do not stop warfarin for extractions
how would we manage the patient who is on warfarin and is scheduled for an extraction
Check INR in his book
if it is stable then check within 72 hours of the extraction
if INR is unstable you check within 24 hours of the extraction
what is abnormal bleeding usually caused by
iatrogenic i.e. caused by medication
what medication causes abnormal bleeding
anti-platelet or anti-coagulant drugs
give 4 examples of anti platelet drugs
aspirin
dipyridamole
clopidogrel
ticlopidine
give 4 examples of anti coagulant drugs
warfarin
dabigatran
apixaban
rivaroxaban
what is the common suffix of anticoagulant s
an