Nikcevich - Clinical Aspects Of Coagulation

Front 1

Required for hemostasis:
-Platelets
-anti/pro?-coagulant factors (clotting cascade)
-anti/pro?-coagulant factors (protein C, protein S, anti-thrombin III, tPA)
-intact vasculature

Back 1

Procoagulant - clotting cascade
Anti-coagulant - protein C, S, anti-thrombin III, tPA

Front 2

Which factors are associated with which step of clotting?

- Agonist, vWF, Fibrinogen
- Adhesion, Activation, Aggregation

Back 2

Adhesion - vWF
Activation - Agonist
Aggregation - Fibrinogen

Front 3

Which 4 coagulation factors are Vitamin K dependent?

Back 3

Factor II, VII, IX, X
(2, 7, 9, 10)

Front 4

Which drug inhibits vitamin K dependent glycosylation (factors II, VII, IX, X) and therefore causes blood to be less prone to coagulation?

Back 4

Coumadin (Warfarin)

Front 5

Heparin works on factors __ and __ - part of the common pathway of coagulation

Back 5

Factors II and X

Front 6

Antithrombin works particularly through blocking thrombin, factor __

Back 6

factor II

Front 7

CBC - normal platelet count around 150-400K. Becomes a serious risk for mucocutaneous bleeding and CNS hemorrhage at what count?

Back 7

Less than 10K

Front 8

Platelet ____ ____ is even more important than the actual number of platelets

Back 8

surface area

Front 9

What is the most common reason for impaired platelet function?

Back 9

Aspirin (ASA)

Front 10

What happens to platelets with NSAIDs?

Back 10

Usually nothing, NSAIDs have reversible platelet inhibition

Front 11

Prothrombin time is now known as ____, and is the assay used to measure what drug?

Back 11

INR = International Normalized Ratio
Warfarin

Front 12

Activated partial thromboplastin time (aPTT) is used to measure what drug?

Back 12

Heparin
Unfractionated NOT low-molecular weight

Front 13

A way to measure heparin LEVELS, need to specify UFH or LMWH

Back 13

Chromogenic Xa assay measures levels.
Function is measured by PTT

Front 14

PFA-100 measures function of _______ in response to ADP, collagen, epinephrine.

Back 14

platelets
Doesn't reveal the etiology of platelet function defect

Front 15

Test that measures platelet function by nicking the arm.

Back 15

Bleeding time

BAD TEST! Use PFA to measure platelet function

Front 16

Which drug causes irreversible acetylation of platelets with an effect that lasts up to 10 days

Back 16

Aspirin
Only way to get platelet function back before the 10 days is giving a transfusion

Front 17

Which drugs have a reversible effect on platelet function that reverses in 6-8 hours?

Back 17

NSAIDs
Ibuprofen, naproxen sodium, ketorolac, sulindac, indomethacin

Front 18

What test helps you determine the dose of Warfarin (coumadin) to use?
How do you reverse warfarin?

Back 18

INR
Time, Vitamin K, Fresh frozen plasma

Front 19

Clopidogrel is used after major _____ events. Can cause bleeding or thrombotic thrombocytopenic purpura (TTP).

Back 19

cardio (cardiac stents, stroke)

Front 20

Argatroban and lepirudin are direct ______ inhibitors used in heparin induced thrombocytopenia

Back 20

thrombin

Front 21

tPA (tissue plasminogen activator) for direct fibrinolysis used with what conditions?

Back 21

MI, stroke, PE

Front 22

What is used to reverse warfarin and is helpful with coagulopathy of liver disease?

Back 22

Vitamin K

Front 23

DDAVP is only useful for what type of vW disease?

Back 23

Type 1 - impaired production
(type 2 - defective, type 3 - none made)

Front 24

What drug increases vWf production by vascular epithelium?

Back 24

DDAVP

Front 25

Fresh frozen plasma (FFP) contains _______ ______ at normal levels. May reverse what drug's effect? And replaces factors missing due to liver disease or DIC

Back 25

coagulant factors
Warfarin

Front 26

________ provides fibrinogen, vWf, factor VIII, factor XIII, fibronectin

Back 26

Cryoprecipitant
(1U = 10U of FFP)

Front 27

In a diagnostic exam - what do you always do first?

Back 27

Take History!
Previous bleeding? Previous thrombosis? Medications? Family hx?

Front 28

Prolonged bleeding, petechiae and easy bruising, skin and mucus membranes, and non-recurrent bleeding are all signs of what defects?

Back 28

Vascular/Platelet

Front 29

Prolonged bleeding, deep hematomas, hemarthrosis, and recurrent bleeding are all signs of what defects?

Back 29

Coagulation

Front 30

Things you would check for in a pt with elevated ____:
Hx, use of heparin, lupus-anticoagulant or anti-phospholipid antibody, liver disease, mixing study

Back 30

aPTT

Front 31

Ask the following question for a patient with elevated ___:
Hx, warfarin use, anti-phospholipid antibody, liver disease, vitamin K deficiency, mixing study

Back 31

INR

Front 32

For thrombocytopenia you would want to know if the patient has used any ______

Back 32

heparin - heparin induced thrombocytopenia (HIC) (low platelets)

Front 33

For _______ you inquire if there is a primary process (myeloproliferative disorder) or secondary process (reactive, inflammation, iron-deficiency)

Back 33

Thrombocytosis (high platelet count)

Front 34

For uncomplicated, non-life-threatening DVT/PE, how long would you keep patient on warfarin? What target INR?

Back 34

6 mos or longer
INR = 2-3

Front 35

For a life-threatening DVT/PE/arterial thrombosis, how long would you keep a patient on on anti-coagulants?

Back 35

Indefinitely

Front 36

How long would you keep patient if they had an uncomplicated first DVT/PE and is homozygous for an inherited coagulopathy? Heterozygous?

Back 36

indefinite anticoagulation

at least 6 mos of warfarin with target INR 2-3

Front 37

___ filter is indicated for someone how can't handle a PE (initial or recurrent). Does NOT substitute for anti-coagulation

Back 37

IVC (inferior vena cava)

Front 38

If you are going to go from UFH/LMWH to warfarin, what is the protocol?

Back 38

Must be on heparin plus coumadin for 4-5 days becaise heparin's action terminates within hours but coumadin's takes several days. After 4-5 days then warfarin monotherapy.