Coagulation COPY Flashcards
Enoxaparin reversal
Protamine (reverses IIa not Xa)
Plt activation
adenosine diphophate
thrombin
Platelet aggregation
binding of fibrinogen to GPIIb/IIIa ->allows coagulation cascade to proceed with fixation of prothrombinase complex -> GPIIb/IIIa binds VWF, fibrinogen
LMWH (enoxaparin)
avoid in Cr >2.5
if Cr mod dysfxional then check Xa levels with dose adjustment
APLS (unprovoked)
coumadin INR 2-3
NO NOACS
Provoked DVT
1st incident - 3-6 months
2nd and beyond lifelong
Cancer
A/C as long as cancer active
PROVOKED DVT
w/in 3 month
trauma, surgery, immobility, hormonal tx
3-6 mo A/C
Unprovoked
No antecedent event OR Active CA thormbopilia fhx Lifelong A/C
Warfarin interactions
Amiodarone INCREASES levels - need to decrease warfarin dose 25-33%
A/C d/c prior to cabg
3 hours Bivalirudin
12-24 hours for LMWH (enoxaparin)
24 hours for fondaparinux
Fondaparinux (Xa inhibitor)
if need PCI - add UFH - risk of catheter related thrombosis (does not inhibit IIa ie thrombin)
avoid with CrCl<30
UFH (anti-thrombin III enhancement) - inactivates IIa ie thrombin IXa and Xa
Heparin induced thrombocytopenia
- usually resolves with d/c of heparin
- may need direct thrombin inhibitor (ie argatroban) to mitigate thrombotic effect of HIT)
Bivalirudin, Argatroban - direct thrombin inhibitos
thrombin inhibition without involvement of anti-thrombin III
Pt with HIT and ACS
Use bivalirudin
can’t use fondaparinux for PCI because need coadmin of heparin
