1. three initial responses to vascular injury
    • vasoconstriction mediated by TXA
    • platelet adhesion
    • thrombin generation
  2. four things needed to initiate the extrinsic pathway
    • exposed collagen
    • prekallikrein
    • HMW kininogen
    • factor XII
  3. prothrombin complex
    • X
    • V
    • Ca
    • Platelet factor 3
    • prothrombin
  4. crosslinks fibrin
  5. tissue factor pathway inhibitor inhibits
    factor X
  6. role of thrombin
    • converts fibrinogen
    • abctivates V and VIII
    • activates platelets
  7. factors whose activity are lost in stored blood
    • V and VIII
  8. vit k dependent factors
    • II
    • VII
    • IX
    • X
    • C and S
  9. what kind of enzymes are coagulation factors
    • serine proteases except
    • V VIII are glycoproteins
    • XIII transglutaminase
  10. normal half life of platelets
    7 days
  11. normal half life of PMNs
    2 days
  12. AT-III inhibits
    factors IX, X, XI
  13. Protein C degrades
    V and VIII
  14. tPA released from
  15. plasmin does what
    • degrades V and VIII
    • degrades fibrinogen and fibrin
  16. natural inh of plasmin released from endothelium
    alpha-2 antiplasm
  17. drug that inhibits plasmin
    aminocaproic acid
  18. PGI2 function
    • released from endothelium
    • inhibits platelet aggregation
    • causes vasodilation
  19. how does PGI perform its role
    increases cAMP in plts
  20. how does TXA2 induce plt aggregation
    increases intracellular Ca which then exposes GpIIb/IIIa aand IB receptors
  21. best test for liver synthetic function test
  22. PT measures which factor
    II, V, VII and X
  23. PTT does not measure which factors
    VII and XIII
  24. MC congenital hypercoagulable state
    resistance to activated protein C
  25. MC acquired hypercoagulable state
  26. tx hyperhomocysteinemia
    folate, pyridoxine, cyanocobalamine
  27. 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
  28. keys to lupus anticoagulant
    elevated PTT that does not correct with FFP-only phospholipids

    + russel viper venom time

    false + RPR
  29. dx polycythemia vera
    • decreased EPO
    • increaed red cell mass
    • normal peripheral smear
    • hypercellular bone marrow and megakaryocyte hyperplasia
  30. best test for diagnosing polycythemia vera
    red cell mass
  31. who needs a year long treatment for dvt or PE
    • 2nd time
    • Ca
    • nonmodifiable risk factor
  32. what pts with DVT or PE need lifelong coumadin
    • 3rd PE
    • life-threatening PE
    • idiopathic
  33. what pts are considered low risk and only need early ambulation
    • minor surgery
    • age <40
    • anesthesia <30 min
    • no RFs
  34. IVC filter indications
    • DVT/PE with contraindication to coumadin
    • failure of anticoagulation
    • free floating ileofemoral/caval
  35. IVC prophylaxis is indicated when
    • pts with DVT undergoing surgery
    • pts with chronic pulm problems and low reserve
  36. PE with filter in place- clot comes from where
    • ovarian veins
    • IVC
    • SVC route
  37. pathophys of HITT
    IgG to PF4
  38. HITT is clinically suspected when
    • plt drop <100 or 50% below baseline
    • thrombosis
  39. dx HITT
    ELISA for PF4-heparin ab

    if only mildly positive then perform C serotonin release assay
  40. tx of HITT
    • d/c heparin
    • start argatroban or bivalirudin
    • convert to coumadin for 3mo if thrombosis or 1 mo if no thrombosis
  41. MC congenital bleeding disorder
  42. mc sx of vWD
  43. tx modalities for vWD
    • DDAVP (except for III)
    • Humate P
    • Cryoprecipitate
  44. tx Glanzmanns and Bernard-Soulier
  45. best option for uremic coagulopathy in elective surgeries
    HD the day before
  46. uremic coagulopathy occurs when
  47. lab findings in DIC
    • prolonged PT PTT
    • decreased plts
    • decreased fibrinogen
    • increased FDPs
  48. why is bleeding at circumcision not a good screening question
    it can miss Hemophilia A
  49. tx hemophilia A
    • recombinant VIII
    • DDAVP if activity >5%
    • cyro
  50. surgery for hemophilia A
    • preop levels 100%
    • post op levels 50% for 3-5 days
  51. surgery for Hem IX
    • preop levels 50%
    • post op levels 50% for 3-5 days
  52. factor def in hemophilia C
  53. 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
  54. pt with mechanical valve and needs emergency general surgery
    • completely reverse with FFP but limited vitk
    • start heparin after 48 hrs
  55. adenosine reuptake inh
  56. cAMP phosphodiesterase inh
  57. glycoprotein IIb/IIIa inh
  58. abx that can increase bleeding time
  59. argatroban metabolized by
  60. how do you follow argatroban
    factor X levels
  61. mc use of bivalirudin
  62. metabolism of bivalirudin
    proteinase enzyme met
  63. what should you follow when using thrombolytics
    fibrinogen levels
  64. metabolism of heparin
    cleared by RES, mainly in spleen
  65. long term heparin side effects
    • osteoporosis
    • alopecia
  66. what can cause the protamine rxn
    crossreaction with NPH or previous exposure to protamine
  67. action of LMWHs
    selective Xa inh
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