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Clinical 4th Year > Chapter 3- Coagulation > Flashcards

Chapter 3- Coagulation Flashcards

(60 cards)

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1
Q

Name three major parts of haemostasis

A

Vasospasm
Platelet plug formation
Coagulation

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2
Q

Give an overview of vasospasm in haemostasis

A

Damaged artery, collagen exposed, contract to prevent blood gushing out

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3
Q

Give an overview of platelet plug formation in haemostasis

A

Platelet adhesion to injured site

Platelets release adenosine biphosphate, serotonin and prothrombin A2 recruiting more platelets to site = plug formation

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4
Q

Give an overview of the coagulation/clotting step of haemostasis

A

Intrinsic and extrinsic pathway lead to prothrombinase

Prothrombinase converts prothrombin to thrombin, thrombin converts fribrinogen to fibrin

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5
Q

How is the clot broken down once damaged is healed

A

Healing and fibrolysis

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6
Q

During fibrinolysis what does the endothelium release and what does it convert?

A

Release tPA

Concerts plasminogen to plasmin

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7
Q

Plasmin cleaves X-linked fibrin polymer into what eventually?

A

D-D (d-dimer) and E

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8
Q

Deficiency in what 3 anticoagulants can increase someone’s risk of VTE?

A

Antithrombin
Protein C
Protein S

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9
Q

Name two abnormal proteins that can increase someone risk of VTE

A

Factor V Leiden

Fibrinogen (dysfibrinogenaemia)

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10
Q

List two procoagulants that can increase someone’s risk of VTE

A

Prothrombin 20210

Factor VIII

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11
Q

Abnormal metabolism of what can increase someone’s risk of VTE

A

Hyperhomocysteinaemia

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12
Q

List three LMWH

A

Dalteparin
Enoxaparin
Tinzaparin

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13
Q

What are the high, moderate and low scores in the wells pre-test probability of DVT

A

High: >2
Moderate: 1-2
Low: <1

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14
Q

What are the high moderate and low scores in the wells pre test probability of PE

A

High: >6
Moderate: 2-6
Low: <2

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15
Q

Which heparin is preferred for patients in renal failure?

A

Unfractionated heparin

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16
Q

How do you manage VTE in pregnancy

A

Heparins are used as they don’t cross the placenta

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17
Q

Which type of heparin in preferred in pregnancy?

A

LMWH because it has a lower risk of osteoporosis and of heparin induced thrombocytopenia

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18
Q

Name a reversal agent for heparin

A

Protamine

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19
Q

If a patient who has had a hip replacement is on DOAC then admitted to hosp with infection do they need VTE prophylaxis?

A

No as on DOAC

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20
Q

When using dalteparin in pregnancy to treat VTE what do you need to ensure the vial does not contain?

A

Benzyl alcohol

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21
Q

True or false and why: you can’t put in epidural unless the patient has not had heparin for 12hours

A

True due to bleeding risk

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22
Q

Pregnant lady has VTE .. what contraceptive can she have after birth?

A

POP not COC

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23
Q

Can you be in warfarin whilst breastfeeding

A

Yes

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24
Q

If having a C-section when should you stop LMWH

A

12-24hours beforehand

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25
After birth when should you start LMWH and for how long
Start 12hours after birth for 10 days
26
Can the wells score be used in pregnancy
No
27
Is the D-dimer test useful in pregnancy
No high rate of false positives
28
Is warfarin contraindicated in pregnancy?
Yeh
29
What is heparin and how does it work?
Glycosaminoglycan: pentasaccharide sequence binds to lys and arg on AT producing a conformational change which increases AT activity
30
What factors does AT inhibit
Factor 11, 9, 10 and thrombin
31
Differences between UFH and LMWH
LMWH has less effect on thrombin and obvs a lower molecular weight, LMWH is s/c only whereas UFH is IV and s/c, LMWH is renally excreted only whereas UFH is renal and hepatic
32
What's the half life of LMWH
4-5 hours
33
What's the half life of UFH
60mins
34
What monitoring is required for UFH
APTT: activated partial thromboplastin time
35
When using APTT what is the normal range for time to clot? And what does APTT principally reflect
28-36seconds | Reflects anti-IIa activity
36
What is used to monitor LMWH
Anti-factor Xa assay
37
List 3 complications of UFH use
Under/overdosage Osteoporosis Heparin-induced thrombocytopenia
38
What is heparin induced thrombocytopenia
Platelet activating autoantibodies to heparin-PF4 complexes
39
When should you be alert to potential HIT
If platelet count falling
40
Name the vitamin K dependent coagulation factors
9, 10, 7
41
What does warfarin inhibit
Vitamin K epoxide reductase
42
What's the best method of monitoring warfarin
Prothrombin time then INR= prothrombin time/ geometric mean of normal prothrombin time
43
When should you consider giving vitamin K in warfarin overdose?
INR >8
44
Name two hirudins
Argatroban | Desirudin
45
Name a synthetic heparin like molecule
Fondaparinux
46
Name a direct anti-IIa inhibitor
Dabigatran
47
Name three direct anti-Xa inhibitors
Rivaroxaban Apixaban Edoxaban
48
List 4 advantages of the NOACs
Oral Reproducible PK Rapid onset No monitoring required
49
When should you take care with using NOACs
Peri-operative anticoag Epidural anaesthesia Renal impairment Weight <50kg or >120kg
50
How can you reverse rivaroxaban and dabigatran
Prothrombin complex concentrate
51
What is andexanet alpha
Modified anti-FXa variant/decoy (rivaroxaban, apixaban, edoxaban bind to it instead of factor Xa)
52
Name 4 thrombolytic agents
Streptokinase rt-PA, alteplase Reteplase Tenecteplase
53
What condition is a definite indication of using thrombolysis for acute DVT
Phlegmasia coerulea dolens
54
List 10 contraindication of using fibrinolysis in acute MI
``` Recent haemorrhage Trauma Surgery Coagulation defects Peptic ulceration Severe hypertension Acute pulmonary disease Acute pancreatitis Severe liver disease Previous allergic reaction ```
55
List risk factors for VTE
``` Active cancer/cancer treatment Age >60 Dehydration Known thrombophilias Obesity >30 bmi Comorbidities (heart disease, metabolic, endocrine, respiratory, infection, inflammation) Personal history/family HRT COC Varicose veins with phlebitis ```
56
When should you reassess patients risk of bleeding and VTE
Within 24 hours of admission and whenever clinical situation changes
57
Should you offer anti-embolism stockings for VTE prophylaxis in stroke patients
No
58
Advice on VTE prophylaxis in surgical patients
Stop COC and HRT 4 weeks before elective surgery
59
What is the INR target in someone on warfarin with a mechanical heart valve
3.5
60
INR target of someone on warfarin with recurrent DVT
3

Clinical 4th Year (9 decks)

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