Topic 15 Procoagulants and Antifibrinolytics

Question 1

Protamine acid base status?

Answer 1

strongly-cationic (positive)

Question 2

Protamine by itself is a what?

Answer 2

is an anticoagulant: it decreases thrombin generation by inhibiting Factor V activation

Question 3

Protamine median T1/2?

Answer 3

5 minutes

Question 4

Heparins median T1/2

Answer 4

1-2 hours

Question 5

Protamine is a component of what insulin?

Answer 5

NPH - Neutral Protamine Hagedorn

Question 6

Protamine effectiveness in reversing LMWH?

Answer 6

Only partially/unpredictably reverses LMWH. (which sort of limits LMWH’s use.)

Question 7

Protamines effect on fondaparinux?

Answer 7

*Protamine has no effect on fondaparinux

Question 8

Two probs with Protamine?

Answer 8

its an anticoagulant

can have protamine reactions

Question 9

How to administer Protamine?

Answer 9

SLOWLY

Question 10

Contributing factors to Protamine Reactions? (5)

Answer 10

• Redo Surgeries
• Fish allergies
• Diabetics (bc in insulin)
• Vasectomy (why?)
• ”Excessive” dosage - (give slow and right amount)

Question 11

Protamine Reactions are minimized by what?

Answer 11

Slow administration
-Intra-aortic administration (why?)
-Administration with steroids and
antihistamines.

Question 12

Vitamin K is essential for production of what factors?

Answer 12

F II, VII, IX, X
F (2, 7, 9, 10)
Prothrombin, Proconvertin, Christmas and Stuart Factors

Question 13

Two types of Vitamin K

Answer 13

1) K₁:Phytonadione (Mephyton)

2) K₂:Menaquinone

Question 14

The most “clinically” relevant form of Vitamin K for perfusionists

Answer 14

K₁:Phytonadione (Mephyton)

Question 15

How to administer Vitamin K?

Answer 15

MUST give slow IV bc anaphylaxis is a common side affect

requires at least 6 hours to be effective

Question 16

What is a typical FFP dose for Warfarin over-activity?

Answer 16

15ml/kg

Question 17

Antifibrinolytic Drugs? (2)

Answer 17

Aminocaproic Acid (EACA) (Amicar)

• Tranexamic Acid (Cyklokapron, Lysteda)
• Both are synthetic derivatives of the amino acid lysine.
• Statistically clinically indistinguishable, except TA is 10x stronger than Amicar

Question 18

Aminocaproic Acid

Answer 18

Amicar, EACA

Antifibrinolytic Drug

Question 19

Tranexamic Acid (TA)

Answer 19

Cyklokapron, Lysteda

Antifibrinolytic Drug 10X stronger than Amicar

Question 20

Amicar

Answer 20

Aminocaproic Acid

Antifibrinolytic Drug

Question 21

Cyklokapron, Lysteda

Answer 21

Tranexamic Acid

Antifibrinolytic Drug (10x stranger than Amicar)

Question 22

Both Antifibrinolytic Drugs prevent activation of what and reduce what?

Amicar (Aminocaproic Acid) and Tranexamix Acid (Cyklokapron/Lysteda)

Answer 22

prevent plasminogen activation and directly inhibit plasmin which prevents fibrinolysis
•Both significantly reduce post- bypass hemorrhage, especially in patients who have received previous fibrinolytic therapy

Question 23

Aprotinin

Answer 23

Trasylol

Serine Protease Inhibitor (caused renal probs and has been pulled from the market and is now used for investigational/compassionate use)

Question 24

Trasylol

Answer 24

Aprotinin

Serine Protease Inhibitor (cause renal probs and has been pulled from the market and is now used for investigational/compassionate use)

Question 25

Desmopressin

Answer 25

DDAVP

synthetic form of antidiuretic hormone, causes release of VWF which increases FVIII and FXII

Question 26

DDAVP

Answer 26

Desmopressin

synthetic form of antidiuretic hormone, causes release of VWF which increases FVIII and FXII

Question 27

DDAVP - Desmopressin – is there any evidence that it works?

Answer 27

Evidence-Based Note”: There is NO research that indicates the use of DDAVP for bleeding post-bypass decreases the use of blood products (maybe somewhat beneficial when administered in advance.)

Question 28

FFP contains what factors??????

Answer 28

FFP contains Factors I, II, V, VII, IX, X, XI, XIII, AT-III, and proteins C & S..

(Factors 1, 2, 5, 7, 9, 10, 11, 13)

Question 29

What is FFP used for?

Answer 29

• Used for “bleeding”
• Used for immediate warfarin reversals (why? why not Vitamin K? - bc Vit K take like 6 hours to be effective)
• Used for AT-III deficiency (why not AT-III? bc ATIII is $$$)
• Used with large volumes of PRBC administration (why? - bc all the clotting factors have been washed away in PRBCS)
• Used for colloidal volume replacement

Question 30

How much FFP will raise the pts ATIII levels by 20%

Answer 30

20 ml/kg

but is super variable bc who knows how much ATIII is in there. cant use on Jehovahs

Question 31

20ml/kg will raise what in a pt?

Answer 31

their ATIII levels 20%

but is super variable bc who knows how much ATIII is in there. cant use on Jehovahs

Question 32

what is Cryoprecipitate derived from ?

Answer 32

Derived from the precipitate that forms after FFP is thawed and centrifuged

Question 33

What is Cryoprecipitate (Cryo) used for?

Answer 33

Used for Factor I , VIII, and von Willebrand’s replacement
(1. Fibrinogen, 8. Antihemophilic factor A)
• BUT, levels of VIII and VWF are “iffy” and cryoprecipitate is NOT treated in any way whatsoever to decrease the risk of viral exposure!!!

Question 34

What are the two blood products

Answer 34

FFP and Cryo

Question 35

Cryoprecipitate 1 unit = ?ml

Answer 35

15 ml

Question 36

Cryoprecipitate 15ml = ? mg fibrinogen?

Answer 36

250-350 mg fibrinogen

Question 37

Cryo 15ml = ?unit = ? mg fibrinogen

Answer 37

15 ml = 1 unit = 250-350 mg fibrinogen