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N929 - Anesthesia Pharmacology > Emergent Reversal of Anticoagulants > Flashcards

Emergent Reversal of Anticoagulants Flashcards

1
Q

reversal for antiplatelet

A

platelet transfusion

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2
Q

reversal for heparin

A

protamine

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3
Q

reversal for vitamin K antagonists

A
  • 3 and 4 factor PCCs

- vitamin K

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4
Q

reversal for direct thrombin inhibitors

A
  • idarucizumab

- andexanet alfa

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5
Q

FFP

A
  • variable but near normal levels of coagulation factors, coagulation inhibitors, albumin, immunoglobulins
  • large volumes not well tolerated in patient with limited cardiopulmonary reserve, can be associated with TRALI
  • efficacy commonly assessed by PT/INR, PTT, fibrinogen level, plt count, viscoelastic tests
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6
Q

cryoprecipitate

A

-slowly thawing FFP leaves behind a cold-insoluble precipitate which contains fibrinogen, FVIII, vWF, and FXIII

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7
Q

factor concentrates

A
  • plasma derived

- recombinant

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8
Q

blood product administration

A
  • filter + warmer –> PRBCs, FFP, Cryo

- filter only (NO warmer) –> plts

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9
Q

plasma derived factor concentrates

A
  • Riastap
  • Profilnine
  • KCentra
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10
Q

recombinant factor concentrates

A

Factor VIIa, Factor IX

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11
Q

Plasma Derived Fibrinogen Concentrate drug

A

Ristap

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12
Q

Ristap MOA

A

fractionated from blood and stored at room temp for up to 30 months

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13
Q

Ristap dose/route

A

concentrate standardized in each vial (900-1300 mg per 50 mL vial)

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14
Q

Ristap admin considerations

A

quickly reconstituted and administered IV with no thawing or blood type matching required

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15
Q

Factor Complex Concentrates drugs

A

Kcentra – 4 factor

Profilnine – 3 factor

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16
Q

Factor Complex Concentrates uses

A
  • reverse effects of significant vitamin K-antagonism
  • emergent or urgent surgery
  • clotting deficiency
17
Q

Factor Complex Concentrates contraindications

A

DIC and HIT

18
Q

3 Factor Concentrate Profilnine MOA

A

complex concentrate which contains factors IX, II, X and low levels of VII

19
Q

3 Factor Concentrate Profilnine dose

A

10-15 units/IBW kg; max dose 1000 units

20
Q

3 Factor Concentrate Profilnine uses

A
  • hemophilia B treatment

- reserved for cardiac cases

21
Q

4 Factor Concentrate Kcentra MOA

A

contains antithrombotic proteins C and S and heparin; also factors II, VII, IX, and X

22
Q

4 Factor Concentrate Kcentra uses

A
  • reversal of vitamin K antagonists with INR > 1.5 and experiencing acute major bleeding
  • potential to reverse factor Xa inhibitors
23
Q

4 Factor Concentrate Kcentra risks

A

potential for increased risk of thrombosis in some settings, particularly in patients who do not have hemophilia

24
Q

Recombinant Activated Factor VII drug

A

Novoseven

25
Q

Novoseven composition

A
  • form of blood factor VII

- glycoprotein produced by recombinant DNA technology

26
Q

Novoseven MOA

A

-activated form of factor VII, causes coagulation without the need for factors VIII and IX
-promotes hemostasis by activating the extrinsic pathway of coagulation cascade
-theoretically, localizes action of factor VIIa to the site of injury
2 pathways:
-site of tissue injury combine with tissue factor directly activate factor X
-platelet surface

27
Q

Novoseven PK/PD

A

E ½ 2-2.5 hours

28
Q

Novoseven dose

A
  • highly variable 20-200 mcg/kg
  • 90 mcg/kg IV (most places use this dose)
  • reconstitute with sterile water
  • re-dose Q2H
29
Q

Novoseven clinical use

A
  • hemophilia A (deficiency of VIII)
  • hemophilia B (deficiency of IX)
  • congenital factor VII deficiency
  • off label for prevention and treatment of major blood loss
30
Q

Novoseven risks/considerations

A
  • risk of thrombotic adverse events
  • will not stop surgical hemorrhage
  • reduce need for transfusion in patients with hemorrhagic shock from blunt trauma
  • should not be given instead of other blood products, adequate FFP, cryo, and plts need to be present
  • provide faster correction of coagulopathy
  • less risk of infectious and noninfectious transfusion reactions
  • dosing requires hematology and pharmacy consultations

N929 - Anesthesia Pharmacology (12 decks)

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