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41 Cards in this Set
- Front
- Back
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Coagualtion is done by what 2 body systems
TPA Anticoag can be used for ACS( unstable angina, NSTEMI, STEMI), pts w mechanical heart valve Atrial fibrillation, DVT/PE, Thombophilla Prevent catheter thrombosis |
Platelets and 13 clotting factors
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W is the first to activate in clot formation and it’s driven by what
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Plts driven by vascular injury
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Which of the pathways is driven by bld stasis or slow bld flow
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Intrinsic pathway (venous thrombosis)
Extrinsic pathway is driven by vascular injury (aterial thrombosis) |
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Thrombin + Fibrin =_____
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Clot formation
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What is the virchow’s triad
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Hypercoagulable state, Endothelial injury, circulatory stasis
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What are ex of hypercoaguable states
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Pregnancy ( pressing on deep vein)
CA pts, genetic abnormality (either making too much clotting factor or not enough) |
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What r the Anti thrombotic agents
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Antiplatelets eg ASA, Clopidogrel, Prasugrel
Thrombolytics: dissolve clots Anticoagualants eg warfarin, heparin, LMWH, Xa inhibitor, DTI |
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What is the body’s natural thromboltic
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TPA
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Anticoag can be used for
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ACS( unstable angina, NSTEMI, STEMI),
pts w mechanical heart valve Atrial fibrillation, DVT/PE, Thombophilla Prevent catheter thrombosis |
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W r the risk factors for DvT/PE
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Age >75
Recent hip or knee surgery Broken bones, Paryalysis, hx of DVT/PE, family Hx of bld clot or clotting D/O, Obesity, MI, Heart failure CA, recent surgery, bedrest, Central venous access, birth control pills |
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What is the MOA of heparin (UFH)
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Binds to Anti thrombin 3 and enhances the inhibition of thrombin
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How would u dose heparin (UFH) in your pt prophlactically and for Tx
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5000 Units SC bid or tId – prophylactic use
80 units/Kg IV bolus 18 units/kg/hr ie 80:18 in Tx |
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APTT is monitored in heparin Tx, What is the target end point when on heparin Tx
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APTT = 1.5-2.5 x baseline (35 secs) =~ 70 sec after Tx w/ heparin
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How freq should u check for therapeutic levels once heparin is intiaited
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Q 6hs until therapeutic level is achieved
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These 2 things other parameters to be monitored while on heparin Tx
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Blding and Heparin Induced thrombocyt
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What is the MOA for LMWH- Enoxaparin (lovonox), Deltaoparin (fragmin)
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Targets Xa and IIa
Has longer half life vs heparin w/ shorter ½ life Given SC |
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How would u dose Enoxaparin***
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Prophylaxis – 30 mg or 40 mg SC Q
Tx – 1 mg/kg SC q 12hrs if no renal problems 1mg/kg SC q 24 hrs if renal problems w/ CrCl < 30ml/min Obeses pts: 1mg/kg Sc q 12 hrs based on body wgt up to 150 mg SC q 12 hs |
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W r the advan of using LMWH – enoxaparin
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No need to blood test monitoring
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Although no reg bld test required , w can be monitored in pregnant women , renal dxfn, obese pts
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Xa levels 0.5 – 1 units/ml
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Diff btw heparin and LMWH is
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Heparin:
Reliable absorption SC Longer 1/2 life <thrombocytopenia Predictable therapeutic effect No bld test req for monitoring LMWH: IV cos is not reliable Shorter 1/2 life >HIT >Predictable TE aPTT test required |
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Fondaparinaux (Arixtra) is used mostly of Tx of __
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HIT
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What is the MOA of Warfarin (Coumadin)
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Inhibit Vit K clotting factor
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W 2 drugs were listed as most interaction ie DDI
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Antibiotics
Other bld thinners (antiplts and NSAIDS) |
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What would be monitored w Tx Coumadin
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Prothrombin time PT (most relied upon)
INR |
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When is warfarin Contraindicated in pregnancy
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1 + 2 trimester but can be used relatively in the 3rd TM
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What does INR due?
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corrects mathematically for the diff of the PT ration used by different labs
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In the dosing of Warfarin why is it not recom to use a large loading dose intially
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Increase hemorraghic complications
No rapid protection |
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Dose of Warfarin should be
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Start low at 5mg QD
Titrate to appropriate INR Monitor INR frequently |
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W is the therapeutic INR
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2-3
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On your 1st episode of VTE Tx with warfarin would last for how long
2nd episode would require what period of Tx |
3-6 mths
Lifelong Tx |
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How long should the INR be monitored once stabilized
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1-4 wks and adjust if needed
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Ur INR should be 2-3 what would u do if your pts starts to bleed
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INR
<5-<8.9 Hold warfarin until INR is range +/- Vit K 2.5 mg PO IV if rapid reversal needed |
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What is the risk of over tx with Vit K
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Long lasting in the fat cells so it would prevent warfarin from reaching Therapeutic range so use little at a time
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W is necessary to bridge pts on warfarin/LMWH
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Use LMWH until warfarin with takes a while to kick in is therapeutic
Use UFH if pt is going in for surgery since it has short ½ life or stop LMWH 1 day before surgery. |
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What role does Protein C +S play in the initiation of warfarin
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Its inhibited by warfarin initially making the bld more thicker ie Hypercoag
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Who need to get bridged b4 medical procedures
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Low risk – single VTE > 12mths ago w/ no other risk factors
High - Recent VTE ~3mths Severe thrombophillia –protien C+S def Anti thrombin Moderate – VTE~ 3-12mths, Non severe thrombophillia, active CA, recurret VTE |
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How do u dose for bridging in High to moderate risk
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Last dose of warfarin on dat 5 pre-op
Vit K 2.5mg PO Day 1-2 pre –op if INR >1.5 IV UFH?SC LMWH if INR <TRange Start IV UFH 6hrs pre-op or Stop LMWH 24hrs pre-op Warfarin 12-24hrs post op at usual maintainance dose |
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How do you dose for bridging in Low Risk
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Last dose warfaring day 5 pre op
Vit K 2.5 PO day 2 or Day 1 if INR > or = 1.5 Warfarin 12-48 hrs post op at usual maintenance dose |
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When is bridging absolutely necessary
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before dental procedures When it involves the bone /root and multiple extractions
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Ur pt education on Warfarin should include w
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What Warfarin is
What its SE – bleeding and concerns for large vol F-up bld work Food and DDI – leafy greens has vit K pts should take the same qty of greens each time to maintain consistent Therepeutic range |
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W r the SE of Enoxaparin
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Brusing at the site of injection, bleeding
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