Clinical Aspect of Coagulation and Hemostasis II
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| Approximately what percentage of proximal DVTs are associated with pulmonary embolism? | Approximately 50%
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| What is the appearance of an extremitiy with an arterial thrombosis? | Extremities are blue, cold, and pulseless.
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| What type of clot is platelet rich and white in appearance? | Aterial thromi
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| (T or F) Methylene tetrahydrofolate reductase results in primary elevated homocysteine levels. | True.
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| What are the antiphospholipid antibodies? | 1)Lupus anticoagulant 2)Prothrombin antibodies 3)Anti-cardiolipin antibodies 4)B2 Glycoprotein 1 antibodies
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| What are the clinical criteria for Antiphospholipid syndrome? | 1)Vascular thrombosis (artieral or venous) 2)Pregnancy complicatons
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| What are the laboratory criteria for Antiphospholipid syndrome? | 1)Anti-cardiolipin Antibody (IgG or IgM) 2) Positive Lupus anticoagulant assay
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| What is the suggested evaluation for venous thromboembolism in a patient with no previous family or personal history? | 1)Lupus anticoagulant and anticardiolipin Ab 2)Homocysteine level 3)Consider Factor V Leiden, Factor II mutation, Factor VIII level, Fibrinogen studies 3)Rule out estrogen and vasculitic risk factors
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| What is the suggested evaluation for arterial thrombosis? | 1)Lupus anticoagulant and anticardiolipin Ab 2)Homocysteine level 3)Lipid levels 4)Rule out estrogen and vasculitic risk factors
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| What are the accepted indications for thromboytic therapy? | 1)Acute myocardial infarctions 2)Acute peripheral arterial occlusive disease 3)Massive pulmonary embolism associated with hemodynamic instability
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| What are the contraindications to thrombolytic therapy? | 1)Major internal bleeding in the last 6 mo 2)Intracranial or intraspinal disease 3)Operation or biopsy in the preceding 10 days 4)HTN (sys >200, dia>110) 5)Active endocarditis 6)Pericarditis 7)Aneurysm 8)Presence of bleeding disorder
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| What is the mechanism of Argatroban? | Reversible Direct Thrombin (FIIa) Inhibitor
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| What is the mechanism of Bivalirudin? | Reversible Direct Thrombin(IIa) Inhibitors
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| What is the mechanism of Lepirudin? | Irreversible Direct Thrombin (IIa) Inhibitors
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| What pharmacologic agents are indirect Factor Xa Inhibitors? | 1)Heparin 2)Low Molecular Weight Heparin 3)Fondaparinux
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| Why does aPTT need to be standarized before comparing from different clinical laboratories? | 1)aPTT reagents differ in phospholipid content and contact activators 2)aPTT and heparin levels may be discordant due to effects of plasma proteins
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| Factor Xa to Factor IIa activity of unfractionated heparin vs. low molecular weight heparin | UFH= 1:1 vs. LMWH 4:1 - 2:1 (LMWH have less than 19 saccharide units therefore they lack thrombin inhibition)
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| What are the advantages of LMWH? | 1)Better predictability of anticoagulant effect at a given dose;therefore, less need for lab monitoring 2)Longer plasma half-life 3)Less effect on the hemostatic properties of the endothelium and platelets perhaps accounting for less hemorrhagic potential
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| (T or F) LMWH never need monitoring. | False. Patients with changing or decreased kidney function must be monitored. Also, very large or very small and pregnant patients may need dose adjustments
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| (T or F) LMWH is fully reversible with protamine. | False. LMWH is only partially reversible with protamine.
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| What is the half-life of heparin? | Varies by dose (average is 1-2 hours)
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| What is the half-life of LMWH? | 4-6 hours
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| What is the half-life of Fondaparinux (Arixtra)? | 15-18 hours
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| What pharmalogical agent reverses the effects of heparin? | Protamine
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| Are the anticoagulant effects of fondaparinux reversible? | No
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| How is LMWH excreted? | Renally
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| How is fondaparinux excreted? | Renally
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| How are the anticoagulant effects monitored by LMWH? | Anti-Xa assay
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| How are the anticoagulant effects monitored by fondaparinux (Arixtra)? | Anti-Xa assay
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| How is heparin administered? | IV or SQ
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| How is LMWH administered? | SQ
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| How is fondaparinux administered? | SQ
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| What is the half-life of Argatroban? | 39-51 mins
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| What is the half-life of Lepirudin? | 1.5 hours
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| What is the half-life of Bivalirudin? | 25 mins
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| Are the anticoagulant effects of Argatroban reversible? | No
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| Are the anticoagulant effects of Lepirudin reversible? | No
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| Are the anticoagulant effects of Bivalirudin reversible? | No
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| How is Argatroban excreted? | Metabolized by the liver
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| How is Lepirudin excreted? | Renally
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| How is Bivalirudin excreted? | Renally
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| How is Argatroban administered? | IV
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| How is Lepirudin administered? | IV
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| How is Bivalirudin administered? | IV
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| What is the half-life of warfarin? | 36-42 hours
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| What are the complications of warfarin therapy? | 1)Bleeding 2)Warfarin induced skin necrosis 3)Cholestatic jaundice 4)Nausea/vomiting 5)Alopecia 6)Mouth ulcers 7)Rash
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