-
three initial responses to vascular injury
- vasoconstriction mediated by TXA
- platelet adhesion
- thrombin generation
-
four things needed to initiate the extrinsic pathway
- exposed collagen
- prekallikrein
- HMW kininogen
- factor XII
-
prothrombin complex
- X
- V
- Ca
- Platelet factor 3
- prothrombin
-
-
tissue factor pathway inhibitor inhibits
factor X
-
role of thrombin
- converts fibrinogen
- abctivates V and VIII
- activates platelets
-
factors whose activity are lost in stored blood
- V and VIII
- NOT LOST IN FFP
-
-
what kind of enzymes are coagulation factors
- serine proteases except
- V VIII are glycoproteins
- XIII transglutaminase
-
normal half life of platelets
7 days
-
normal half life of PMNs
2 days
-
AT-III inhibits
factors IX, X, XI
-
Protein C degrades
V and VIII
-
tPA released from
endothelium
-
plasmin does what
- degrades V and VIII
- degrades fibrinogen and fibrin
-
natural inh of plasmin released from endothelium
alpha-2 antiplasm
-
drug that inhibits plasmin
aminocaproic acid
-
PGI2 function
- released from endothelium
- inhibits platelet aggregation
- causes vasodilation
-
how does PGI perform its role
increases cAMP in plts
-
how does TXA2 induce plt aggregation
increases intracellular Ca which then exposes GpIIb/IIIa aand IB receptors
-
best test for liver synthetic function test
PT
-
PT measures which factor
II, V, VII and X
-
PTT does not measure which factors
VII and XIII
-
MC congenital hypercoagulable state
resistance to activated protein C
-
MC acquired hypercoagulable state
smoking
-
tx hyperhomocysteinemia
folate, pyridoxine, cyanocobalamine
-
how do you diagnose anti phospholipid syndrome
need 1 clinical criteria of thrombosis event or complication of pregnancy
need 1 lab criteria of increased anticardiolipin or lupus coagulant
-
keys to lupus anticoagulant
elevated PTT that does not correct with FFP-only phospholipids
+ russel viper venom time
false + RPR
-
dx polycythemia vera
- decreased EPO
- increaed red cell mass
- normal peripheral smear
- hypercellular bone marrow and megakaryocyte hyperplasia
-
best test for diagnosing polycythemia vera
red cell mass
-
who needs a year long treatment for dvt or PE
- 2nd time
- Ca
- nonmodifiable risk factor
-
what pts with DVT or PE need lifelong coumadin
- 3rd PE
- life-threatening PE
- idiopathic
-
what pts are considered low risk and only need early ambulation
- minor surgery
- age <40
- anesthesia <30 min
- no RFs
-
IVC filter indications
- DVT/PE with contraindication to coumadin
- failure of anticoagulation
- free floating ileofemoral/caval
-
IVC prophylaxis is indicated when
- pts with DVT undergoing surgery
- pts with chronic pulm problems and low reserve
-
PE with filter in place- clot comes from where
- ovarian veins
- IVC
- SVC route
-
pathophys of HITT
IgG to PF4
-
HITT is clinically suspected when
- plt drop <100 or 50% below baseline
- thrombosis
-
dx HITT
ELISA for PF4-heparin ab
if only mildly positive then perform C serotonin release assay
-
tx of HITT
- d/c heparin
- start argatroban or bivalirudin
- convert to coumadin for 3mo if thrombosis or 1 mo if no thrombosis
-
MC congenital bleeding disorder
vWD
-
-
tx modalities for vWD
- DDAVP (except for III)
- Humate P
- Cryoprecipitate
-
tx Glanzmanns and Bernard-Soulier
plts
-
best option for uremic coagulopathy in elective surgeries
HD the day before
-
uremic coagulopathy occurs when
>60-80
-
lab findings in DIC
- prolonged PT PTT
- decreased plts
- decreased fibrinogen
- increased FDPs
-
why is bleeding at circumcision not a good screening question
it can miss Hemophilia A
-
tx hemophilia A
- recombinant VIII
- DDAVP if activity >5%
- cyro
-
surgery for hemophilia A
- preop levels 100%
- post op levels 50% for 3-5 days
-
surgery for Hem IX
- preop levels 50%
- post op levels 50% for 3-5 days
-
factor def in hemophilia C
XI
-
mgmt of plavix in elective surgery
bare metal 6 weeks and drug eluting 1yr before elective surgery
- stop 5-7 days before
- asa perioperative
- plavix asap post op
-
pt with mechanical valve and needs emergency general surgery
- completely reverse with FFP but limited vitk
- start heparin after 48 hrs
-
adenosine reuptake inh
dipyridamole
-
cAMP phosphodiesterase inh
pentoxifylline
-
glycoprotein IIb/IIIa inh
eptifibatide
-
abx that can increase bleeding time
pcn/cephalosporins
-
argatroban metabolized by
liver
-
how do you follow argatroban
factor X levels
-
mc use of bivalirudin
PTCA
-
metabolism of bivalirudin
proteinase enzyme met
-
what should you follow when using thrombolytics
fibrinogen levels
-
metabolism of heparin
cleared by RES, mainly in spleen
-
long term heparin side effects
-
what can cause the protamine rxn
crossreaction with NPH or previous exposure to protamine
-
action of LMWHs
selective Xa inh
|
|