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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

22
Q

Normal INR value in healthy patients is

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
_______ monitors for fibrinolysis
D-dimer
26
If fibrinolysis is increased, there's likely
a thrombus present
27
Normal value of D-dimer is
<500 mg/mL
28
Differential in the setting of elevated d-dimer includes
DVT, PE, & DIC
29
A platelet count less than 20,000 increases the risk of
spontaneous bleeding
30
The TEG provides a "real-time" visual representation of disorders of
coagulation and fibrinolysis
31
The basic components of the TEG include
R time K time alpha angle maximum amplitude amplitude at minutes after maximum amplitude
32
R time is the time to
begin forming the clot
33
K time is the time
until the clot has achieved fixed strength
34
Alpha angle is the
speed of fibrin accumulation
35
maximum amplitutude is the
measurement of clot strength
36
Amplitude at minutes after maximum amplitude is the
height of vertical amplitude 60 minutes after the maximum amplitude
37
Normal r time is
6-8 minutes
38
If R time is abnormal, the problem area is
coagulation factors
39
The treatment for abnormal R time is
FFP
40
The normal value for K time is
3-7 minutes
41
The problem area for abnormal K values is
fibrinogen
42
The treatment for abnormal K value is
Cryo
43
The normal value of the alpha angle is
50-60 degrees
44
The problem area for abnormal alpha angle is
fibrinogen
45
The treatment for abnormal alpha angle is
cryo
46
The normal value of maximum amplitude is
50-60 mm
47
The problem area for abnormal maximum amplitude is
platelets
48
The treatment for abnormal maximum amplitude is
Plts +/- DDAVP
49
The normal value for amplitude at minutes after maximum amplitude is
MA-5
50
The problem area for abnormal amplitude at minutes after maximum amplitude is
excessive fibrinolysis
51
The treatment for abnormal amplitude at minutes after maximum amplitude is
tranexamic acid aminocaproic acid

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