Exam 2 - thrombo disorders Flashcards
(88 cards)
1
Q
sequence for primary hemostasis
A
platelet adhesion, activation, aggregation
2
Q
secondary hemostasis
A
coagulation cascade that leads to a fibrin clot
3
Q
intrinsic pathway
A
involves Factors XI, IX–>VIII/X
4
Q
extrinsic pathway
A
involves TF, Factor VII –>X
5
Q
common pathway
A
starts with Factor X–>fibrin clot
6
Q
4 inhibitors of the coagulation cascade
A
AT (antithrombin III), PC (protein C), PS (protein S), PAI (Plasminogen activator inhibitor)
7
Q
venous thrombosis
A
“red clots”- composition is almost entirely fibrin and erythrocytes with small platelet head; can form in any part of venous system, usually in response to either venous stasis or vascular injury
8
Q
3 components of Virchow’s triad
A
Vascular injury, stasis, hypercoagulability
9
Q
Examples of Venous thrombosis
A
DVT, PE
10
Q
Arterial thrombosis
A
“white clots” - platelets + fibrin in areas of rapid blood flow in response to an injured or abnormal vessel wall
11
Q
examples of arterial thrombosis
A
MI, CVA, TIA
12
Q
Trauma
A
Transient
13
Q
Major orthopedic surgery
A
Transient
14
Q
Major medical illness
A
Acquired
15
Q
Major surgery
A
Transient
16
Q
Paralysis/immobility
A
Acquired
17
Q
Obesity
A
Acquired
18
Q
Varicose veins
A
Acquired
19
Q
Malignancy
A
Acquired
20
Q
IBD
A
Acquired
21
Q
Hormone therapy
A
Transient
22
Q
Pregnancy
A
Transient
23
Q
APA syndrome
A
Acquired
24
Q
Factor V Leiden
A
Inherited
25
Protein C deficiency
Inherited
26
Protein S deficiency
Inherited
27
Antithrombin III deficiency
Inherited
28
DVT defintion
thrombus that forms in venous
29
PE definition
an embolism that usually arises from a thrombus in the venous system that dislodges and then lodges in the pulmonary vasculature causing complete or partial obstruction of blood flow
30
diagnostic criteria for VTE
Clinical manifestations, risk factor assessment, objective tests, hyper coagulable work-up
31
indications for Hypercoagulable work-up
<40 y/o and idiopathic
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manifestations of DVT: location
can occur in any vein (usually lower extremities; distal or proximal (knee)
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manifestations of DVT: Sx
edema, tenderness, pain, erythema, warmth, often unilateral
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manifestations of DVT: physical exam
palpable cord, homan's sign: + if pain behind the knee or calf upon dorsiflexion of the foot
35
manifestations of DVT: complications
Acute: PE, limb viability
Chronic: recurrent VTE, post-thrombotic syndrome
36
manifestations of PE: common sx
chest pain, dyspnea, tachypnea, tachycardia, hemoptysis
37
manifestations of PE: other sx (not common)
palpitations, cough, diaphoresis, low-grade fever, hypotension
38
manifestations of PE: ominous signs
CV collapse (characterized by cyanosis, shock, and oliguria)
39
manifestations of PE: complications
Acute: death, right ventricular dysfunction
Chronic: recurrent VTE, pulmonary HTN, cor pulmonale
40
5 etiologies of Cardioembolic stroke
A.Fib, Heart valve replacement, Recent MI, Left ventricular mural thrombus, Left ventricular dysfunction
41
thrombogenicity of types/positions of heart valve replacements
1. muliple valves > mitral valve > Aortic valve
| 2. Caged ball > Single-tilting disk > Bileaflet-tilting disk > Bioprosthetic
42
measures alterations in the intrinsic pathway of clotting cascade; used to monitor heparin therapy
aPTT
43
measures EXTRINSIC pathway of clotting cascade and is used to monitor warfarin therapy
PT
44
measures anti-Xa activity and may be used to monitor LMWH and fondaparinux
Anti-Xa
45
measures activity of factors 7-11
ACT
46
manifestations of DVT: complications
Acute: PE, limb viability
Chronic: recurrent VTE, post-thrombotic syndrome
47
manifestations of PE: common sx
chest pain, dyspnea, tachypnea, tachycardia, hemoptysis
48
manifestations of PE: other sx (not common)
palpitations, cough, diaphoresis, low-grade fever, hypotension
49
manifestations of PE: ominous signs
CV collapse (characterized by cyanosis, shock, and oliguria)
50
manifestations of PE: complications
Acute: death, right ventricular dysfunction
Chronic: recurrent VTE, pulmonary HTN, cor pulmonale
51
5 etiologies of Cardioembolic stroke
A.Fib, Heart valve replacement, Recent MI, Left ventricular mural thrombus, Left ventricular dysfunction
52
thrombogenicity of types/positions of heart valve replacements
1. muliple valves > mitral valve > Aortic valve
| 2. Caged ball > Single-tilting disk > Bileaflet-tilting disk > Bioprosthetic
53
measures alterations in the intrinsic pathway of clotting cascade; used to monitor heparin therapy
aPTT
54
measures EXTRINSIC pathway of clotting cascade and is used to monitor warfarin therapy
PT
55
measures anti-Xa activity and may be used to monitor LMWH and fondaparinux
Anti-Xa
56
measures activity of factors 7-11
ACT
57
Parenteral agents: heparin
Unfractionted heparin (UFH)
58
Parenteral agents: LMWH
Enoxaparin, Dalteparin, Tinzaparin
59
Parenteral agents: Factor Xa inhibitors
Fondaparinux
60
Parenteral agents: Direct thrombin inhibitors
Lepirudin, Bivalirudin, Desirudin, Argatroban
61
Oral agents: Vit. K antagonists
Warfarin
62
Oral agents: Factor Xa inhibitors
Rivaroxaban, Apixaban
63
Oral agents: Direct thrombin inhibitors
Dabigatran
64
Contraindications for anticoagulant therapy
Active bleeding
hemophilia
severely, uncontrolled HTN
inability to meticulously supervise and monitor (warfarin)
65
Risk factors for major bleeding while on anticoagulation therapy
HTN, Abnormal renal/hepatic fxn, Recent surgery or history of stroke, Bleeding hx, Labile INRs on warfarin tx, Elderly, Drugs or alcohol
66
tx recommendation: biosprosthetic valve in aortic position
Long-term ASA 81mg daily
67
tx recommedation: bioprosthetic valve in mitral position
Warfarin 1st 3 mos (INR 2-3), then long-term ASA 81mg daily
68
tx: Mechanical valve in aortic position
Long-term warfarin (INR 2-3)
69
tx: Mechanical valve in mitral position
Long-term warfarin (INR 2.5-3.5)
70
tx: Mechanical valve in both positions
Long-term warfarin (INR 2.5-3.5)
71
Nonpharmacologic measures for prevention of VTE
Early ambulation: walk in hall 6x/day
IPC: wear compression device up to 18 hrs/day
GCS: graduated compression stockings
IVC filter: invasive, last option, requires insertion of filter to catch a clot that dislodges from a leg vein
72
VTE prevention: LD UFH (low dose UFH)
5000 U SC BID or TID
73
Prophylactic dose: Fondaparinux
2.5mg SC daily
74
Prophylactic dose LMWH: Enoxaparin
30mg SC q 12 H OR
| 40 mg SC q 24 H
75
Prophylactic dose LMWH: Dalteparin
2500 U or 5000 U SC q 24 H
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Prophylactic dose: Rivaroxaban
10 mg PO daily
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VTE prevention: ASA
81-325 mg PO daily
78
Prophylaxis: Very low risk general surgery
Early ambulation
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Prophylaxis: Low risk general surgery
mechanical prophylaxis (IPC)
80
Prophylaxis: Moderate risk general category
LD UFH, LMWH, or IPC
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Prophylaxis: High risk general surgery
LD UFH, or LMWH + GCS or IPC
82
Prophylaxis: Moderate-High risk general surgery with increased bleeding risk
mechanical prophylaxis (IPC)
83
Prophylaxis:Orthopedic surgery (knee or hip replacement)
LMWH (preferred), Fondaparinux, Warfarin (INR 2-3), Rivaroxaban, ASA, or IPC.
84
Prophylaxis: acutely ill hospitalized medical patients at increased risk of thrombosis
LD UFH, LMWH, or Fondaparinux
85
Acutely ill hospitalized medical patients who are bleeding or at high risk for bleeding
Mechanical prophylaxis (GCS or IPC)
86
Duration of tx of acute coagulation
minimum of 5 days or until INR stable for 24H (patients transitioned to warfarin tx)
87
Drugs used for chronic anticoag
Warfarin (INR target 2-3), continued LMWH (cancer patients), new: Rivaroxaban for both acute and chronic
88
Duration of Chronic anticoag.
1st VTE, secondary to transient risk factor: 3 mos.
1st VTE, unprovoked: at least 3 mos.
Recurrent VTE: Long-term
