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BOARDS > SESAP Hemostasis/Coagulation > Flashcards

SESAP Hemostasis/Coagulation Flashcards

1
Q

In vivo coagulation - First phase?

A

Platelet plug

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2
Q

Platelet adhesion requires

A

glycoprotein 1b + vWF

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3
Q

Platelet aggregation requires

A

glycoprotiein IIb/IIIa reception and fibrinogen

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4
Q

What also occurs with platelet plug formation?

A

Vasoconstriction

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5
Q

Coagulation pathways -

primary method of coagulation in vivo ?

A
  1. exposed TF from subendothelium
  2. TF complexes with F7.
  3. active F7 activates F10
  4. active F 10 activated F2 (thrombin)
  5. THROMBIN IS LIFE…. thrombin activates F5
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6
Q

Coagulation pathways -

secondary method of coagulation in vivo ?

A
  1. active F7 activates F9 (Hemophillia b, A = 8)
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7
Q

Coagulation pathways -

tertiary method of coagulation in vivo ?

A
  1. active F2. activates F11

2. active F11 activates F9, F10 (potentiates F2)

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8
Q

What is thrombin?

What does it do?

A
  1. Thrombin is everything. Factor 2
  2. Activated by F10
  3. Activates F5, F11
  4. Fibronigen to fibrin
  5. platelet aggregator
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9
Q

Coagulation factors -
not in liver?
require Vit K?

A
  1. F8, vWF, AT III

2. 2,7,9,10

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10
Q

Nature’s anticoagulation systems - name the three

A
  1. TFPI –> blocks TF-7A complex
  2. Protein C/S –> protein C + cofactor protein S blocks 5, 8 with the help of thrombin
  3. ATIII–> attaches to thrombin + F10.
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11
Q

How to treat ATIII deficiency?

A

Resistant to Heparin. Treat with FFP

recurrent thrombosis in arterial/venous systems.

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12
Q

How to treat Protein C deficiency?

A

young patients. giving warfarin will cause skin necrosis.

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13
Q

Factor V Leiden mutation?

A

activated protein C resistance –> recurrent thrombosis –> LMWH.

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14
Q

Last phase of hemostasis – fibrinolysis

What is this?

A

Plasminogen –> plasmin to cleave Fibrin.
hypoxia and acidosis release tPa, UPA from endothelial cells –> in break down of clot.
a-2 antiplasmin blocks fibrinolysis

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15
Q

HIT -

  1. Presentation?
  2. Workup?
  3. Treatment?
A
  1. > 50% drop in Tb
  2. IgG, pF3. ELISA for anti-heparin pF3/PF4 Ab.
  3. Argatroban (metabolized in liver/RENAL FAILURE PATIENTS); Fonduparinox (metabolized in renal/USE IN LIVER FAILURE)
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16
Q

PE -

  1. Presentation?
  2. Workup?
  3. Treatment?
A
  1. Tachycardia, new O2 requirement.
    EKG - S1G3T3 features –> Core Pulmonale.
  2. CT Angiogram.
  3. Heparin gtt bolus dose with infusion rate. 70-80U/kg initial, rate 15 U/kg/hr (STEMI - 60 U/Kg then 12 U/kg/hr)
17
Q

INR Reversal

Warfarin reversal agents?

A
  1. PCC –> emergent. (2,7,9,10)
  2. FFP, INR 1.6 (takes 6 hours….)
  3. Vitamin K –> PO/IV.
18
Q

Warfarin

MOA?

A
  1. Vit K dependent factors. full effect for 2-3 days.
  2. Needs to be bridged.
  3. Takes 3-5 days without products for things to normalize. F 2 1/2 life is 60 days.
  4. INR monitoring.
19
Q

Dabigatran, argatroban, fondapurinox

MOA?

A

Direct thrombin inhibitor
Renal
fondapurinox –> can be used in liver failure
Peak 3 hrs
Reverse - HD or Idarucizumab *Ab fragments

20
Q

Rivaroxaban, Apixaban

MOA?

A

Oral Xa inhibitor
Rivar - river –> Renal and lIVER.
Apixaban - hepatic
Reverse - PCC

21
Q

Heparin

MOA?

A

ATIII potentiator

reverse with Protamine (induce HC state) –> protamine also works on LMWH and can neutralize Anti Xa activity partially.

22
Q

Plavix - Clopidogrel

MOA?

A

Platelet inhibits, INHIBIT P2Y12 R
Check P2Y12 platelet assay to assess degree of platelet inhibition. gives % of inhibition. (want less than 20% inhibition
Hold for 5 days.

STENTS -
bms - 3 months (d/c after)
drug eluting - 12 months (d/c after)

23
Q

How to reverse patients on antiplatelets?

A
  1. Wait.
  2. Platelets. (circulating drug levels may impair new Tb as well) –> still the standard.
  3. DDAVP to increase vWF and V8 to increase platelet aggregation.
24
Q

platelet tests

A
  1. P2Y12 Receptot assay
  2. TEG
  3. Bleeding time – platelet function (not count)
25
Q

platelet tests

A
  1. P2Y12 Receptor assay
  2. TEG
  3. Bleeding time – platelet function (not count)
26
Q

LMWH - loVENOX

A
  1. ptt does NOT measure activity

2. need Anti-XA activity assay.

27
Q

PTT prolonged - what is happening?

A
  1. heparin

2. Hemophillias A -8, B - 9, X-linked recessive.

BOARDS (17 decks)

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