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SPR25: Health Assessment > Other > Flashcards

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1
Q

What are the goals of hemostasis?

A
  • To limit blood loss from vascular injury
  • Maintain intravascular blood flow
  • Promote revascularization after thrombosis
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2
Q

What are the two stages of hemostasis?

A
  • Primary Hemostasis
  • Secondary Hemostasis
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3
Q

What occurs during Primary Hemostasis?

A

Immediate platelet deposition at the endovascular injury site.

Leading to initial platelet plug formation and only adequate for minor injury

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4
Q

What occurs during Secondary Hemostasis?

A

Clotting factors are activated, leading to a stabilized clot formed and secured with crosslinked fibrin.

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5
Q

What role do vascular endothelial cells play in hemostasis?

A

They have antiplatelet, anticoagulant, and fibrolytic effects to inhibit clot formation.

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6
Q

What are some anti-clotting mechanisms of endothelial cells?

A
  • Negatively charged to repel platelets
  • Produce platelet inhibitors such as prostacyclin and nitric oxide
  • Excrete adenosine diphosphatase
  • Increase protein C, an anticoagulant
  • Produce Tissue Factor Pathway Inhibitor (TFPI)
  • Synthesize tissue plasminogen activator (t-PA)
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7
Q

What is the lifespan of platelets?

A

8-12 days.

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8
Q

What are the two types of storage granules in platelets?

A
  • Alpha granules
  • Dense bodies
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9
Q

What do alpha granules contain?

A
  • Fibrinogen
  • Factors V & VIII
  • von Willebrand factor
  • Platelet-derived growth factor
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10
Q

What do dense bodies contain?

A
  • ADP
  • ATP
  • Calcium
  • Serotonin
  • Histamine
  • Epinephrine
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11
Q

What are the three phases of platelet alteration upon ECM exposure?

A
  • Adhesion
  • Activation
  • Aggregation
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12
Q

What initiates the Extrinsic Pathway?

A

Endothelial injury exposing tissue factor (TF) to the plasma.

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13
Q

What complex does TF form with to activate factor X?

A

TF forms an active complex with factor VIIa (TF/VIIa complex).

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14
Q

What is the role of factor Xa in the hemostatic process?

A

Factor Xa begins the final common pathway.

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15
Q

What is the main function of the Intrinsic Pathway?

A

It amplifies thrombin generation initiated by the extrinsic pathway.

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16
Q

What activates factor XII in the Intrinsic Pathway?

A

Contact with a negatively charged surface.

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17
Q

What does the Common Pathway involve?

A

Factor X becomes Xa and binds with Va to form the prothrombinase complex.

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18
Q

What does thrombin do?

A

Converts fibrinogen (I) to fibrin (Ia) and stabilizes the clot.

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19
Q

What is Fibrinolysis?

A

The process where endovascular TPA & urokinase convert plasminogen to plasmin, breaking down clots.

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20
Q

What are the four major coagulation counter-mechanisms?

A
  • Fibrinolysis
  • Tissue factor pathway inhibitor (TFPI)
  • Protein C system
  • Serine Protease Inhibitors (SERPINs)
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21
Q

What is Von Willebrand’s Disease?

A

The most common inherited bleeding disorder, characterized by deficiency in von Willebrand factor.

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22
Q

What is Hemophilia A?

A

Factor 8 (VIII) deficiency occurring in 1 in 5,000 individuals.

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23
Q

What is the primary cause of drug-induced bleeding?

A

Anticoagulant medications.

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24
Q

What is the significance of liver disease in hemostasis?

A

It leads to impaired synthesis of coagulation factors and platelet dysfunction.

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25
What is Disseminated Intravascular Coagulation (DIC)?
A pathological hemostatic response causing excessive activation of the extrinsic pathway.
26
What are the lab findings in DIC?
* Decreased platelets * Prolonged PT/PTT * Increased soluble fibrin & fibrin degradation products
27
What is the most common inherited prothrombotic disease?
Factor V Leiden mutation.
28
What is Antiphospholipid Syndrome?
An autoimmune disorder characterized by antibodies against phospholipid-binding proteins.
29
What is Heparin-Induced Thrombocytopenia (HIT)?
Mild-moderate thrombocytopenia associated with heparin, characterized by platelet count reduction.
30
What does Prothrombin Time (PT) assess?
Integrity of extrinsic and common pathways, reflecting deficiencies in factors 1, 2, 5, 7, 10.
31
What does Activated Partial Thromboplastin Time (aPTT) measure?
Integrity of intrinsic and common pathways, sensitive to deficiencies in factors 8 & 9.
32
What is the Anti-factor Xa activity assay used for?
Functional assessment of heparin's anticoagulant effect.
33
What is the standard component measured in coagulation labs?
Platelet Count.
34
What does the intrinsic pathway assess?
Integrity of intrinsic and common pathways
35
Which factors are most sensitive to deficiencies in the intrinsic pathway?
Factor 8 & 9 (VIII, IX)
36
What is the purpose of the anti-factor Xa activity assay?
Provides functional assessment of heparin's anticoagulant effect
37
What is a normal platelet count?
Plt count >100,000 plts/microliter
38
What does Activated Clotting Time (ACT) measure?
Responsiveness to heparin
39
What is the normal range for Activated Clotting Time (ACT)?
107 +/- 13 seconds
40
What does viscoelastic coagulation tests measure?
All aspects of clot formation from early fibrin generation to clot retraction & fibrinolysis
41
What are the three main classes of antiplatelet agents?
* Cyclooxygenase Inhibitors * P2Y12 receptor antagonists * Platelet GIIb/IIIa R antagonists
42
What do Cyclooxygenase Inhibitors block?
Cox 1 from forming TxA₂
43
How long do the anti-platelet effects of ASA last after discontinuation?
7-10 days
44
What are the effects of Clopidogrel after discontinuation?
Anti-plt effects x 7 days after d/c
45
What is the most common vitamin K antagonist?
Warfarin
46
What is the half-life of Warfarin?
40 hours
47
What is required for monitoring Warfarin therapy?
Frequent lab monitoring (PT/INR)
48
What is the reversal agent for Warfarin?
Vitamin K
49
How does Heparin work?
Binds to antithrombin→ directly inhibits soluble thrombin and Xa
50
What is the dosing frequency for LMWH?
BID SQ
51
What is the effect of protamine on LMWH?
Only partially effective
52
What are direct thrombin inhibitors?
Bind/block thrombin in both soluble & fibrin-bound states
53
What is the first direct oral anticoagulant (DOAC)?
Dabigatran (Pradaxa)
54
What are the two categories of thrombolytics?
* Fibrin-Specific * Non-Fibrin-Specific
55
Name a fibrin-specific thrombolytic.
Altepase (tPA)
56
What are antifibrinolytics used for?
Mitigate blood loss
57
What is the role of lysine analogues in antifibrinolytics?
Inhibit plasminogen from binding to fibrin
58
What is the preoperative guideline for low risk patients on Warfarin?
Should d/c 5 days prior to surgery & restart 12-24h postop
59
When should UFH be discontinued before surgery?
4-6h prior to surgery
60
What is the recommended waiting period for elective surgery after bare-metal stent placement?
6 weeks
61
What is the emergent reversal agent for Warfarin?
Prothrombin Complex Concentrates
62
What is the antidote for Dabigatran (Pradaxa)?
Idarucizumab
63
What can reverse DOAC Factor Xa Inhibitors?
Andexanet, a derivative of factor Xa

SPR25: Health Assessment (11 decks)

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