Stroke and coagulants Flashcards
What procedures call for use of coagulants?
oral anticoagulant overdoses, CABG, orthopedic procedures
What are 2 ways to enforce clotting?
Facilitate clot cascade, Prevent fibrinolysis
Factors given to hemophiliacs?
Hemophilia A- Factor 8, Hemophilia B- Factor 9
What drugs can prevent coagulopathies?
FEIBA, Novoseven, Prothrombin complex concentrate, Cryoprecipitate
what are uses for anti-inhibitors?
Hemophilia A and B patients for surgery, Pradaxa antidote
ADR for anti-inhibitors
Allergy, Thrombotic events- stroke
What is the MOA for anti-inhibitors?
precursor and activated forms of factors 2,7, 9, 10
Prothrombin complex mechanism?
contains factors 2, 7, 9, 10, protein C and S
Use of prothrombin?
warfarin reversal
how does factor VIIa work?
activates factors 9 and 10, injectable until bleeding stops
Indications for factor VIIa use?
hemophilia A and B, unapproved uses (bleeding from trauma or surgery, intracranial bleeds, warfarin reversal)
what drugs stop fibrinolysis?
aminocaproic acid, tranexamic acid
MOA of aminocaproic acid
binds with plasminogen so it can’t convert to plasmin and plasmin can’t breakdown fibrin
uses of aminocaproic acid
acute bleeding in a surgical setting
MOA of tranexamic acid
displaces plasminogen from fibrin and inhibits fibrinolysis inhibiting the proteolytic activity of plasmin
uses of tranexamic acid
hemophillia to reduce or prevent hemorrhage following tooth extraction, treatment of heavy menstrual bleeding
MOA of topical thrombin
activates platelets and converts fibrinogen to fibrin
MOA of cellulose (oxidized), ferric subsulfate, and gelatin absorbable
aids in clot formation
What is tisseal
fibrin sealant, combination of fibrinogen, fibrin and aprotinin used at surgical sites
uses for desmopressin?
hemophilia and hemostasis
how does desmopressin come as dosage forms?
IV infusion or nasal spray
What does desmopressin increase?
VWF
what are the risk factors for stroke?
HTN, hyperlipidemia, DM, smoking, unhealthy diet, lack of physical activity, obesity
What are the types of hemorrhagic stroke?
intracerebral, subarachnoid hemorrhage, intracerebral aneurysm, arteriovenous malformation (AVMs)
FAST
face, arm, speech, time
etiology of intracerebral hemorrhage
spontaneous rupture of small vessel damage by chronic HTN
Etiology of SAH?
underlying cerebrovascular malformation in an otherwise normal patient
what type of stroke is most common?
ischemic
etiology of intracerebral aneurysm
vessel rupture
Etiology of AVM
congenital vascular anomaly
how is intracerebral hemorrhage controlled and treated?
ABCs, BP control (not too low), analgesia, sedation
How is SAH treated?
prophylactic antiseizure drugs, do NOT lower BP!, CCB (Nimodipine oral liquid)
ADR of Nimodipine
HOTN, HA - greater effects on cerebral arteries than other arteries
treatment goals of ischemic stroke?
prevent/reverse brain injury - ABCs, watch glucose, STAT non-contrast head CT, IV thrombolysis, antithrombotic treatments
How soon do pts with ischemic stroke need to be treated?
3-4.5 hours from onset of sxs, must dx and treat within an hour of presentation, brain tissue not salvageable after 4.5 hours
what gender is mor elikely to have stroke?
women
Treatment of ischemic stroke (drug)?
alteplase (thrombolysis)
what antiplatelet is used in stroke?
clopidogrel
What LDL is it necessary to use atilipemics after stroke?
>120 - want to get it down to 70
when is combination therapy of ASA and clopidogrel after stroke appropriate?
TIAs
what stroke severity score is it not necessary to use alteplase?
<5 - use neuro opinion
what is the oral liquid preparation of CCB for stroke?
Nymalize
how long does it take brain cells to die from ischemia?
4-10 minutes
what is considered high, caution, and low-risk on the stroke risk scorecard?
>3 from high risk, 4-6 from caution, 6-8 from low-risk
what type of stroke has a better prognosis?
ischemic
What coagulant is used in cervical bx?
ferric subsulfate
