Hematology

intrinsic and extrinsic pathway: factors activated by heparin and vitamin K dependent (Coumadin works there)

requires certain clotting factors and calcium. activated by irritation or damage of endothelium (thrombophlebitis)

clotting time is less bc body needs to hurridly clot the laceration or damaged tissue; requres thromboplastin

• retard the clotting process. they DO NOT dissolve already formed clots, just PREVENT clots.
• pt. teaching: minimize risk for injury

• Heparin for initial anticoagulation;
• Coumadin for maintainence

can't be given orally since it can't cross the GI tract

• 1. decrease in platelets--->bleeding
• 2. thromboembolism--->small clots

protamine sulfate if active hemorrhage

• APTT (activated partial thromboplastin time)
• Normal APTT=40 sec.
• Therapeutic if 1.5-2X normal (60-80) (on sliding scale)

• don't require APTT monitoring
• most commonly used in orthopedic surgery
• recommended in acute coronary syndrome
• "parin" family
• enoxaparin (Lovenox)

• used as a rat killer
• works on Vitamin K-dependent factors
• maintenance anticoagulation drug
• used for pre-a-fib, MI, artificial heart valve

• hemorrhage
• ANTIDOTE: Vitamin K
• pt shouldn't eat too many green leafy vegis (spinach, etc.) since it contains vitamin K

• PT (prothrombin time-normal is 12)
• Therapeutic level is 1 1/2X normal (18)
• or INR w/ therapeutic level 2-3

prevent arteriole clots

• bind to COX-1 receptors
• Aspirin-82 mg recommended for pts w/ MI & stroke risk
• 325 mg dose recommended as 1st line drug in management of pt w/ MI
• BP needs to be no more than 150/90

shouldn't be taken together long term

• prevent aggregation w/ irreversible blockade on platelets
• used in pt who had a stroke or risk for stroke
• cardic cath pt: clopidrogel (Plavix)

• block those receptors thereby preventing aggregation
• most commonly used in acute coranary syndrome
• abciximab (Reopro)

• "clot busters"
• primarily used in immediate MI
• "ase" enzymes (form of tPA)
• nurse determine: stroke bc of clot in vessel OR stroke bc of bleeding in brain before administering drug

• window of opportunity: 6 hrs from onset (of symptoms for heart)
• 3-4.5 hrs for stroke
• over 80 y/o w/ previous hx stroke & DM: 3 hrs
• no active bleeding-pt on Coumadin can get it but within 3 hr window & INR <1.7
• no major trauma/surgery within last few months

• promote clot formation
• used to stop excessive bleeding

• don't give it unless hemoglobin <10 g/dL
• whole blood not usually givven (usually just certain component)

• precpitate after thaw plasma : fibrinogen
• albumin: increases colloid osmotic pressure

• "ferrous": iron
• vitamin C enhances absorption
• antacids reduce absorption

stimulates bone marrow to produce blood cells

• "grastim" drugs
• platelet stimulation-- Neumaga