Coagulation Modifiers

Question 1

Coagulation system

Answer 1

cascade process resulting in fibrin which forms clots

Question 2

Fibrinolytic system

Answer 2

• breakdown of clots
• plasmin breaks down fibrin
• keep thrombus in place to prevent embolus

Question 3

Hemostasis

Answer 3

• a general process that stops bleeding
• coagulation

Question 4

Hemophilia

Answer 4

• coagulation/hemostasis factors limited or absent
• pt needs to be given a coagulation factor or they could bleed to death

Question 5

Classes of coagulation modifiers

Answer 5

• Anticoagulants
• Antiplatelet
• Hemorheologic
• Thrombolytics
• Antifibrinolytic/hemostatic

Question 6

Anticoagulants (antithrombotic)

Answer 6

• don’t work on already-formed clots
• decrease blood coagulability
• prevent clot formation emboli

Question 7

MI

Answer 7

when embolus lodges in a coronary artery

Question 8

stroke

Answer 8

embolus obstructs brain vessel

Question 9

pulmonary emboli

Answer 9

in pulmonary circulation

Question 10

Heparins MOA

Answer 10

inhibit clotting factor (thrombin)

Question 11

Types of heparin

Answer 11

Unfractionated heparin (just heparin)
Low molecule weight heparin (LMWH)

Question 12

Enoxaparin (Lovenox) and Dalteparin (Fragmin) drug class

Answer 12

LMWH

Question 13

Unfractionated heparin precaution

Answer 13

aPTT/bleeding times

Question 14

Heparin flush precaution

Answer 14

no monitoring needed

Question 15

What is a heparin flush?

Answer 15

• Dosage (10-100units/mL) is very different from heparin doses used to treat clots
• Used to keep the central line clear

Question 16

LMWH precaution

Answer 16

more predictable, so bleeding time monitoring is not needed

Question 17

Warfarin MOA

Answer 17

• inhibit vitamin K synthesis in the GI tract
• inhibit vitamin K-dependent clotting factors in the liver

Question 18

Lepirudin, Argatroban, Bivalirudin, Dabigatran drug class

Answer 18

Direct thrombin inhibitors

Question 19

Fondaparinux, Ivaroxaban, Apixaban drug class

Answer 19

Selective factor Xa inhibitors

Question 20

Type I Heparin-Induced Thrombocytopenia (HIT)

Answer 20

• Gradual reduction in platelets
• Heparin therapy can usually be continued

Question 21

Type II Heparin-Induced Thrombocytopenia (HIT)

Answer 21

• More than 50% reduction of platelets from baseline
• Discontinue heparin

Question 22

Type III Heparin-Induced Thrombocytopenia (HIT)

Answer 22

• A thrombosis can be fatal
• treated with thrombin inhibitors

Question 23

Purple toes syndrome

Answer 23

Caused by the use of warfarin. Also skin necrosis

Question 24

S/S of HIT

Answer 24

• hematuria
• melena
• petechiae
• ecchymoses
• bleeding gums

Question 25

Antidote for HIT

Answer 25

- Protamine sulfate 1mg IV reverses 100 units of heparin - high doses of K will reverse anticoagulation but cause warfarin resistance (~7 days)

Question 26

treatment of severe bleeding from HIT

Answer 26

- transfusions of plasma or clotting factor - Kcentra or Profiline

Question 27

IV vitamin K precaution

Answer 27

- high doses (>10mg) risk for anaphylaxis - diluting and giving over 30min reduces risk - warfarin resistence

Question 28

Warfarin precaution

Answer 28

monitor INR

Question 29

INR Levels

Answer 29

Normal = 1.0 Therapeutic = 2 - 3.5

Question 30

Aspirin used for

Answer 30

- Ischemic stroke/attack - Chronic stable angina - Unstable angina - Coronary stenting - MI (acute or previous) - MI prevention (Antiplatelet)

Question 31

Aspirin AE

Answer 31

- N/V - bruising - risk of bleeding

Question 32

Clopidogrel MOA

Answer 32

- ADP receptor antagonist - alters the platelet membrane

Question 33

Clopidogrel AE

Answer 33

- chest px - abdominal px - N/V/D

Question 34

Clopidogrel black box warning

Answer 34

genetic abnormalities

Question 35

Clopidogrel indications

Answer 35

- prevent blockage of coronary artery stents - reduces thrombotic events in acute coronary syndromes - MI - Ischemic stroke - Vascular death

Question 36

Alteplase, Reteplase, and Tenecteplase

Answer 36

Thrombolytic drugs

Question 37

Thrombolytics MOA

Answer 37

- Activate fibrinolytic system - Break down clots quickly - Activate plasminogen to convert into plasmin to digest fibrin - This reestablishes blood flow to the heart

Question 38

Thrombolytics indications

Answer 38

- Acute MI - Ischemic stroke - DVT - Arterial thrombolysis - Occlusion of shunts/catheters - Pulmonary embolus

Question 39

Thrombolytics AE

Answer 39

- bleeding - N/V - hypotn - anaphylactoid reactions - dangerous dysrhythmias

Question 40

Antifibrinolytic Drugs

Answer 40

- Prevent lysis of fibrin - Promotes clot formation

Question 41

Antifibrinolytics indications

Answer 41

- Prevention/tx of excessive bleeding d/t hyperfibrinolysis or surg complications - Von Willebrand's dz

Question 42

Aminocaproic acid, Tranexamic acid, desmopressin classification

Answer 42

Antifibrinolytic drugs

Question 43

Antifibrinolytic AE

Answer 43

- usually mild and uncommon - rare thrombotic events - dysrhythmia, ortho hypotn, brady, HA, dizzy, fatigue, N/V/D, abdominal cramping

Question 44

Aspirin interactions

Answer 44

Ginko, decreases the action of aspirin and may cause increased bleeding times