5. Anticoagulant and Inherited Bleeding

Question 1

Contraindications of anticoagulant and inherited bleeding disorders (3)

Answer 1

Aspirin
NSAIDs
Antithrombotic medication (anticoagulants, antiplatelets)

Question 2

Indications for oral anticoagulation (4)

Answer 2

AF
DVT
Heart valve disease/ mechanical heart valves
Thrombophilia

Question 3

Types of oral anticoagulants (4)

Answer 3

Coumarins
Indanediones
Direct thrombin inhibitors
Factor Xa inhibitor

Question 4

Types of wafarin drug interactions (2)

Answer 4

Potentiating drugs

Inhibiting drugs

Question 5

Examples of warfarin potentiating drugs (4)

Answer 5

Amiodarone
Antibiotics
Alcohol (with liver disease)
NSAIDs

Question 6

Examples of warfarin inhibiting drugs (4)

Answer 6

Carbamazepine, barbiturates
Cholesystramine
Griseofulvin
Alcohol (without liver disease)

Question 7

Dangers of warfarin (overdose)

Answer 7

Haemorrhage

Question 8

How do anti platelet drugs affect clotting (2)

Answer 8

Inhibiting platelet aggregation

Inhibiting thrombus formation in arterial circulation

Question 9

Examples of anti platelet medications (8)

Answer 9

Low dose aspirin
Clopidogrel
Dipyridamole
Prasugrel and aspirin
Abciximab
Eptifibate and aspirin
Ticagrelor
Tirofaban

Question 10

Definition of inherited bleeding disorder

Answer 10

Acquired defects which affect blood coagulation

Question 11

What may inherited bleeding disorders affect (3)

Answer 11

Coagulation cascade
Platelet number
Platelet function
Combo

Question 12

Types of rare bleeding disorders (2)

Answer 12

Inherited defects of other factors in coagulation pathway (not FVIII, IX, XI)
Inherited defect of platelet number/function

Question 13

Types of haemophilia (3)

Answer 13

Haemophilia A
Haemophilia B
Haemophilia C

Question 14

Genetics of haemophilia (2)

Answer 14

Sex-linked recessive inheritance

Males affected, females carriers

Question 15

Definition of Haemophilia A

Answer 15

FVIII deficiency

Question 16

Definition of Haemophilia B

Answer 16

FIX deficiency

Question 17

Treatment of severe/moderate Haemophilia A

Answer 17

Use of recombinant factor VIII

Question 18

Treatment of mild/carriers of Haemophilia A (2)

Answer 18

DDAVP

Very mid - oral tanexamic acid

Question 19

Treatment of Haemophilia B (2)

Answer 19

No response to DDAVP

Prophylactic cover requires recombinant FIX

Question 20

Definition of von Willebrand disease

Answer 20

Deficiency of von Willebrand factor

Question 21

Genetics of von Willebrand disease (2)

Answer 21

Autosomal dominant

Both sexes equally affected

Question 22

Types of von Willebrand disease (3)

Answer 22

Type 1 (dominant, mild)
Type 2 (dominant, mild)
Type 3 (recessive, severe)

Question 23

Treatment of von WIllebrand disease (2)

Answer 23

Majority respond to DDAVP

Very mild cases - oral tranexamic acid

Question 24

LA issues with inherited bleeding disorders (2)

Answer 24

IDB, lingual infiltration, post. sup. nerve block

Buccal infiltration, intra-ligamentary, intra-papillary safe

Question 25

Definition of thrombophilia

Answer 25

Acquired condition superimposed on a genetic condition

Question 26

Increased risk of what with thrombophilia

Answer 26

Clot development

Question 27

Types of inherited bleeding syndromes (4)

Answer 27

Protein C deficiency Protein S deficiency Factor V leiden Antithrombin III deficiency

Question 28

How can acquired syndromes be obtained (7)

Answer 28

``` Antiphospholipid syndrome (lupus anticoagulants) Oral contraceptives Surgery Trauma Cancer Pregnancy Immobilisation ```

Question 29

Types of platelet abnormalities (3)

Answer 29

Thrombocytopenia Thrombocythaemia Qualitative disorders (normal platelet number but abnormal function)

Question 30

Definition of thrombocytopenia

Answer 30

Reduced platelet numbers

Question 31

Definition of thrombocythaemia

Answer 31

Increased platelet numbers

Question 32

Types of thrombocytopenia (3)

Answer 32

Idiopathic Drug-related Secondary to lymphoproliferative disorder

Question 33

Types of inherited qualitative disorders (3)

Answer 33

Bernard Soulier syndrome Hermansky Pudlak Glanzmann's thromboasthenia

Question 34

Types of acquired qualitative disorders (4)

Answer 34

Cirrhosis Drugs Alcohol Cardiopulmonary bypass

Question 35

Definition of Haemophilia C

Answer 35

Deficiency of FXI