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Apex Review > Coagulation 4 > Flashcards

Coagulation 4 Flashcards

1
Q

Match each phase of the contemporary model of coagulation to its key event
initiation, propagation, amplification
platelets are activated
a large quantity of thrombin is produced
The TF/7a reaction activates the final common pathway

A

Initiation: The TF/7a reaction activates the final common pathway
Amplification: Platelets are activated
Propagation: a large quantity of thrombin is produced

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2
Q

What are the three phases of the contemporary cell-based cascade?

A

initiation
amplification
propagation

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3
Q

Initiation is when

A

tissue factor is expressed

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4
Q

Amplification is when

A

platelets and cofactors lay the groundwork for large-scale thrombin production

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5
Q

Propagation is when

A

large quantities of thrombin are produced on the surfaces of platelets

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6
Q

The propagation phase begins when factor _ is activated by factors

A

10; activated by factors 4 (Ca2+), 8 & 9 on the surface of the platelet

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7
Q

What is the end result of the initiation phase?

A

a small amount of thrombin (2a) is produced but not enough to activate fibrin

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8
Q

Why do thrombin levels remain low in the 1st phase of the contemporary coagulation model?

A

b/c tissue factor pathway inhibitor limits the amount of tissue factor released

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9
Q

Identify the BEST predictor of bleeding during surgery
a. PT/INR
b. history & physical
c. thromboelastogram
d. bleeding time

A

b. History & physical

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10
Q

____________ assesses the intrinsic and final common pathways

A

Activated partial thromboplastin time (aPTT)

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11
Q

Normal aPTT is

A

25-32 seconds

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12
Q

__________ assesses the extrinsic and final common pathways

A

Prothrombin time (PT)

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13
Q

Normal PT is

A

12-14 seconds

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14
Q

________________ standardizes PT results

A

International normalized ratio

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15
Q

The target INR for a patient on warfarin is

A

2-3 x control

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16
Q

Platelet count monitors __________ but not ___________

A

the number of platelets but not how well the platelets function

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17
Q

______________ monitors platelet function, but it’s seldom used in clinical practice

A

Bleeding time

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18
Q

__________ guides heparin dosing

A

Activated clotting time (ACT)

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19
Q

Normal ACT is

A

90-120 seconds

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20
Q

The ACT should exceed _______ before going on CPB

A

400 seconds

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21
Q

_____________ monitors the therapeutic response to unfractionated heparin but not LMWH

A

PTT

22
Q

Normal INR value in healthy patients is

A

about 1

23
Q

__________ evaluates the ability to form a platelet plug

A

Bleeding time

24
Q

Normal value of bleeding time is

A

2-10 minutes

25
Q

_______ monitors for fibrinolysis

A

D-dimer

26
Q

If fibrinolysis is increased, there’s likely

A

a thrombus present

27
Q

Normal value of D-dimer is

A

<500 mg/mL

28
Q

Differential in the setting of elevated d-dimer includes

A

DVT, PE, & DIC

29
Q

A platelet count less than 20,000 increases the risk of

A

spontaneous bleeding

30
Q

The TEG provides a “real-time” visual representation of disorders of

A

coagulation and fibrinolysis

31
Q

The basic components of the TEG include

A

R time
K time
alpha angle
maximum amplitude
amplitude at minutes after maximum amplitude

32
Q

R time is the time to

A

begin forming the clot

33
Q

K time is the time

A

until the clot has achieved fixed strength

34
Q

Alpha angle is the

A

speed of fibrin accumulation

35
Q

maximum amplitutude is the

A

measurement of clot strength

36
Q

Amplitude at minutes after maximum amplitude is the

A

height of vertical amplitude 60 minutes after the maximum amplitude

37
Q

Normal r time is

A

6-8 minutes

38
Q

If R time is abnormal, the problem area is

A

coagulation factors

39
Q

The treatment for abnormal R time is

A

FFP

40
Q

The normal value for K time is

A

3-7 minutes

41
Q

The problem area for abnormal K values is

A

fibrinogen

42
Q

The treatment for abnormal K value is

A

Cryo

43
Q

The normal value of the alpha angle is

A

50-60 degrees

44
Q

The problem area for abnormal alpha angle is

A

fibrinogen

45
Q

The treatment for abnormal alpha angle is

A

cryo

46
Q

The normal value of maximum amplitude is

A

50-60 mm

47
Q

The problem area for abnormal maximum amplitude is

A

platelets

48
Q

The treatment for abnormal maximum amplitude is

A

Plts +/- DDAVP

49
Q

The normal value for amplitude at minutes after maximum amplitude is

A

MA-5

50
Q

The problem area for abnormal amplitude at minutes after maximum amplitude is

A

excessive fibrinolysis

51
Q

The treatment for abnormal amplitude at minutes after maximum amplitude is

A

tranexamic acid
aminocaproic acid

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