13973273
Description
Flashcards by Jennifer Huber, updated more than 1 year ago
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Created by Jennifer Huber
over 6 years ago
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| Question | Answer |
| What are the 3 initial responses to vascular injury? | vascular vasoconstriction platelet adhesion thrombin generation |
| Intrinsic Pathway | contact activation pathway most often initiated when factor XII (Hageman factor) Activates VIII, IX, XI |
| Extrinsic Pathway | tissue factor pathway quicker responding and more direct releases Factor III + Ca Factor VII is activated |
| Common Pathway | Intrinsic and Extrinsic converge with Factor X. Fibrin is produced to seal off the vessel |
| Prothrombin Complex | X, V, Ca, Platelet factor 3, prothrombin forms platelets catalyzes formation of thrombin |
| What does fibrin do? | links platelets together(binds GpIIb/IIIa molecules) to form platelet plug hemostasis |
| What does Factor XIII do? | helps cross-link fibrin |
| Effects of Thrombin | Fibrinogen --> Fibrin + split products Activates factors V and VIII Activates platelets |
| Effects of Antithrombin III | Binds and inhibits Thrombin Inhibits factors IX, X & XI |
| Effects of Heparin on Antithrombin III | heparin activated antithrombin III up to 1000x normal activity |
| Protein C | Vitamin K dependent degrades factors V and VIII degrades fibrinogen |
| Protein S | vitamin K dependent protein C co-factor |
| Molecules associated with fibrinolysis | tissue plasminogen activator plasmin alpha-2 antiplasmin |
| Tissue Plasminogen Activator | released from endothelium and converts plasminogen to plasmin |
| Plasmin | degrades factors V and VIII, fibrinogen and fibrin. Lose Platelet Plug |
| Alpha-2 Antiplasmin | Natural Inhibitor of Plasmin released from endothelium |
| Factor with the shortest half-life | Factor VII |
| What factors are lost in stored blood but not FFP? | Factor V and VIII |
| Which factor is not synthesized in the liver? Where is it synthesized? | Factor VIII, it is synthesized in the endothelium along with vWF |
| Which Factors are Vitamin K dependent? | II, VII, IX, and X; protein C and S |
| How long does it take for Vitamin K in IV form take to have an effect? | 12 hours |
| What is Factor II? | Prothrombin |
| Normal half-life of RBC | 120days |
| Normal half-life of platelets | 7 days |
| Normal Half-life of PMNs | 1-2days |
| Prostacyclin - where is it from? - what effects does it have? | from endothelium decreases platelet aggregation promotes vasodilation antagonistic to TXA2 increases cAMP in platelets |
| Thromboxane (TXA2) - where is it from? - what are its effects? | from platelets increases platelet aggregation promotes vasoconstriction triggers Ca release from platelets Exposes GpIIb/IIIa-R |
| GpIIb/IIIa receptor | when activated, causes platelet-to-platelet binding |
| GpIb Receptor | When activated, platelet-to-collagen binding |
| Cryoprecipitate - what does it contain? - What diseases is it commonly used for? | contains the highest concentration of vWF-VIII and high levels of fibrinogen; used in vWD and Hemophilia A |
| FFP | Fresh Frozen Plasma high levels of all coagulation factors protein C+S, AT-III |
| DDAVP and conjugated estrogens release which factors? | causes release of Factor VIII and vWF from endothelium |
| What does prothrombin time (PT) measure? | Factors II, V, VII, and X Fibrinogen best for liver synthetic function |
| What does partial thromboplastin time measure? What range do we want? | I, II, V, VIII, IX, X, XI and XII (not factors VII or XIII) Range: 60-90sec |
| Activated Clotting Time we want for routine A/C vs for cardiopulmonary bypass | routine ACT: 150-200sec Cardiopulm Bypass ACT: >480sec |
| relative contraindication to performing surgical procedures (INR) | >1.5 |
| Relative contraindication for placing a central line, percut. needle biopsies, and eye surgery | INR >1.3 |
| MCC of surgical bleeding | incomplete hemostasis |
| MC congenital bleeding disorder | von Willebrand's Disease |
| MC symptom associated with vWD | epistaxis |
| Which type(s) of vWD are autosomal dominant? | Type I and II |
| Which type(s) of vWD are autosomal recessive? | Type III |
| Effects of vWF | links GpIb receptor on platelets to collagen |
| Effects of vWD on PT and PTT | PT normal PTT normal or abn |
| Effects of vWD on bleeding time | Long bleeding time Ristocetin Test |
| MC type of vWD | Type I, mild symptoms |
| Which type of vWD is most severe? | Type III |
| What is Type I vWD? and it's treatment | reduced quantity of vWF Tx: recombinant VIII:vWF, DDAVP, cryoprecipitate mostly DDAVP |
| What is Type II vWD? what is its treatment? | defect in vWF molecule, vWF doesn't work well Tx: recombinant VIII:vWF, cryoprecipitate and DDAVP |
| what is Type III vWD? Treatment? | complete vWF deficiency Tx: Recombinant VIII:vWF, cryoprecipitate NOT: DDAVP |
| What is Hemophilia A? MC symptom? | VIII deficiency Sex-linked recessive MC symptom: hemarthrosis |
| PT and PTT in Hemophilia A | PT: normal PTT: prolonged, follow this 8hrs after surgery |
| What to do for Hemophiliac joint bleeding | ice, keep joint mobile, factor VIII concentrate or cryoprecipitate |
| Treatment for Hemophiliac epistaxis, ICH, or hematuria | recombinant factor IX or FFP |
| Hemophilia B and treatment | IX Deficiency, Christmas Dx sex-linked recessive Tx: recombinant factor IX or FFP |
| PT and PTT in Hemophilia B | PT: normal PTT: prolonged |
| Factor VII deficiency PT & PTT, and treatment | PT: prolonged PTT: normal bleeding tendency Tx: recombinant factor VII or FFP |
| Symptoms associated with Platelet Disorders | bruising, epistaxis, petechiae, purpura |
| What can cause acquired thrombocytopenia | H2 blockers Heparin |
| What is Glanzmann's Thrombocytopenia? Its treatment | GpIIb/IIIa-R deficiency on plts platelets can't bind together Tx: platelets |
| Bernard Soulier and its treatment | GpIb-R Deficiency on platelets cannot bind to collagen Tx: platelets |
| Uremia and its effect on platelets Treatment | BUN >60-80 inhibits plt fxn, mainly but inhibiting release of vWF Tx: HD, for acute reversal use DDVAPm cryoprecipitate for moderate to severe bleeding |
| Antibody associated with HIT syndrome | anti-heparin antibodies or IgG heparin-PF4 antibody |
| Difference between HIT and HITT | HIT: heparin induce thrombocytopenia HITT: thrombosis |
| Clinical Signs of HIT | Platelets <100 or drop in platelets >50% admission levels or thrombosis while on heparin |
| Type a clot that is formed associated with HIT syndrome | white clot |
| Diagnostic Testing for HIT syndrome | ELISA for heparin Abs Serotonin Release Assay |
| Treatment of HIT syndrome | stop heparin start agatroban (direct thrombin inhibitor) avoid giving plts |
| What is DIC? What is increased and decreased on bloodwork? | Disseminated Intravascular Coagulation decreased plts, fibrinogen high D-Dimer fibrin split prod Prolonged PT and PTT |
| Treatment for DIC | treat the underlying cause |
| When do you stop aspirin before surgery? | 7days before surgery |
| MoA and Effects of aspirin | inhibits cyclooxygenase in plts and decreases TXA2 Causes prolonged bleeding time |
| When to Stop Clopidogrel (Plavix) before surgery | 7 days prior to surgery |
| MoA of clopidogrel | ADP receptor antagonist |
| How to treat someone for bleeding while on Clopidogrel/Plavix | Platelets |
| What to do for a patient with coronary stent and need to stop Plavix for elective surgery? | bridge with Integrilin (eptifibatide) GpIIb/IIIa inhibitor |
| Treatment for bleeding in a patient on Coumadin | Vit K and FFP |
| When to stop Coumadin prior to surgery | 7days prior |
| Platelet levels prior to surgery and after surgery | prior >50,000 after >20,000 |
| Effects of prostate surgery on coagulation | It can release urokinase, activate plasminogen and cause thrombolysis |
| Best way to predict bleeding risk | H&P |
| MC congenital hypercoagulability disorder | Factor Leiden V Mutation |
| Effects of Factor Leiden V mutation | causes venous thromboses resistance to activated protein C defect on Factor V |
| Tx for Factor Leiden V mutation | heparin, warfarin |
| Effects of hyperhomocysteinemia and treatment for it | hypercoagulability Tx: folic acid and B12 |
| Prothrombin gene defect G20210A | gene mutation in which a guanine (G) is changed to a adenine (A) at position 20210 in prothrombin gene causes DVT and PE |
| Treatment of G20210A | Heparin, Warfarin |
| Treatment of Protein C or S deficiency | Heparin, Warfarin |
| Polycythemia Vera | BM overproduction can get thrombosis |
| What platelet and Hct levels are expected in patients with Polycythemia Vera prior to surgery? | Hct <48 Platelets <400 |
| Treatments for Polycythemia Vera | Phlebotomy ASA Hydroxyurea |
| Symptoms with Anti-phospholipid antibody syndrome | thromboses and loss of pregnancy |
| Antibodies associated with anti-phospholipid antibody syndrome | cardiolipin (mitochrondria) lupus anticoagulant (cell membrane) |
| Diagnostic Tests for Anti-phospholipid Ab Syndrome (not antibodies) | prolonged PTT, not corrected with FFP (+) Russell viper venom time false positive RPR |
| Treatment for anti-phospholipid antibody syndrome | heparin, warfarin |
| MC factor for acquired hypercoagulability | TOBACCO |
| Name 10 Causes of Acquired Hypercoaguable states | Tobacco, Malignancy, Inflammatory States, IBD, Infections, OCP, Pregnancy, RA, Post-op patients, myeloproliferative disorders |
| Warfarin-induced skin necrosis | when someone is on Coumadin without being heparinized first, d/t short t1/2 of proteins C&S. Esp. in protein C deficiency patients |
| Tx of Warfarin-induced skin necrosis | heparin, otherwise best to just prevent with heparin before starting |
| Virchow's Triad | elements for venous thromboses stasis, endothelial injury, hypercoagulability |
| Key element in the development of arterial thrombosis | Endothelial injury |
| Indications for IVC filter placement | contraindications for A/C PE while on A/C free-floating IVC, ilio-femoral or deep femoral DVT recent pulmonary embolectomy |
| How to treat someone for DVT post-op 1st time? 2nd time? 3rd time? | 1st: Warfarin x 6mon 2nd: warfarin x 1 year 3rd/significant PE: warfarin lifetime |
| MC origin for PE | ilio-femoral region |
| Aminocaproic Acid (amicar) MoA | inhibits fibrinolysis by inhibiting plasmin |
| When to use Aminocaproic Acid | DIC, persistent bleeding following cardiopulmonary bypass, thrombolytic overdoses |
| MoA of Warfarin | prevents vitamin-K dependent decarboxylation of glutamic residues on vitamin K dependent factors |
| List 3 direct thrombin inhibitors (PO) | Dabigatran (Pradaxa) Apixiban (Eliquis) Rivaroxaban (Xarelto) |
| How do sequential compression devices (SCDs) work? | improve venous return and induce fibrinolysis with compression (releases tPA from endothelium) |
| How to reverse heparin | Protamine |
| Half-life of heparin | 60-90minutes |
| How is heparin cleared from the system? | Reticuloendothelial System (spleen, macrophages) |
| Protamine Reaction | Can occur in patients who are on NPH insulin or previous protamine exposure. HoTN, Bradycardia, decreased heart fx |
| which anticoagulant is safer to use in pregnancy? and why? Heparin or Warfarin | Heparin, it does not cross the placental barrier |
| Low Molecular Weight Heparin | Enoxaparin lower risk of HIT compared to unfractionated binds and activated antithrombin-III increases neutralization of Factor Xa |
| Argatroban | reversible direct thrombin inhibitor metabolized by proteinase enzymes in blood half-life is 50minutes |
| Bivalirudin (Angiomax) | reversible direct thrombin inhibitor, metabolized by proteinase enzymes in blood half-life is 25minutes |
| Hirudin (Hirulog) | From Leeches irreversible direct thrombin inhibitor Most potent direct inhibitor of thrombin |
| Ancrod | Malayan pit viper venom stimulates tPA release |
| 3 thrombolytics | tPA Streptokinase Urokinase |
| Absolute Contraindications for Thrombolytics | active internal bleeding; recent CVA or Neurosurgery (<3mo); intracranial pathology, recent GI bleed |
| Major Contraindications to Thrombolytic Use | Recent (<10d) surgery, organ biopsy, or obstetric delivery, left heart thrombosis, active peptic ulcer, recent major trauma, uncontrolled HTN, recent eye surgery |
| Minor Contraindications to Thrombolytics | minor surgery, recent CPR, AFib with mitral valve disease, bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, pregnancy |
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