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Lecture 31

Clinical Aspect of Coagulation and Hemostasis II

Approximately what percentage of proximal DVTs are associated with pulmonary embolism? Approximately 50%
What is the appearance of an extremitiy with an arterial thrombosis? Extremities are blue, cold, and pulseless.
What type of clot is platelet rich and white in appearance? Aterial thromi
(T or F) Methylene tetrahydrofolate reductase results in primary elevated homocysteine levels. True.
What are the antiphospholipid antibodies? 1)Lupus anticoagulant 2)Prothrombin antibodies 3)Anti-cardiolipin antibodies 4)B2 Glycoprotein 1 antibodies
What are the clinical criteria for Antiphospholipid syndrome? 1)Vascular thrombosis (artieral or venous) 2)Pregnancy complicatons
What are the laboratory criteria for Antiphospholipid syndrome? 1)Anti-cardiolipin Antibody (IgG or IgM) 2) Positive Lupus anticoagulant assay
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
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
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
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
What is the mechanism of Argatroban? Reversible Direct Thrombin (FIIa) Inhibitor
What is the mechanism of Bivalirudin? Reversible Direct Thrombin(IIa) Inhibitors
What is the mechanism of Lepirudin? Irreversible Direct Thrombin (IIa) Inhibitors
What pharmacologic agents are indirect Factor Xa Inhibitors? 1)Heparin 2)Low Molecular Weight Heparin 3)Fondaparinux
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
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)
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
(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
(T or F) LMWH is fully reversible with protamine. False. LMWH is only partially reversible with protamine.
What is the half-life of heparin? Varies by dose (average is 1-2 hours)
What is the half-life of LMWH? 4-6 hours
What is the half-life of Fondaparinux (Arixtra)? 15-18 hours
What pharmalogical agent reverses the effects of heparin? Protamine
Are the anticoagulant effects of fondaparinux reversible? No
How is LMWH excreted? Renally
How is fondaparinux excreted? Renally
How are the anticoagulant effects monitored by LMWH? Anti-Xa assay
How are the anticoagulant effects monitored by fondaparinux (Arixtra)? Anti-Xa assay
How is heparin administered? IV or SQ
How is LMWH administered? SQ
How is fondaparinux administered? SQ
What is the half-life of Argatroban? 39-51 mins
What is the half-life of Lepirudin? 1.5 hours
What is the half-life of Bivalirudin? 25 mins
Are the anticoagulant effects of Argatroban reversible? No
Are the anticoagulant effects of Lepirudin reversible? No
Are the anticoagulant effects of Bivalirudin reversible? No
How is Argatroban excreted? Metabolized by the liver
How is Lepirudin excreted? Renally
How is Bivalirudin excreted? Renally
How is Argatroban administered? IV
How is Lepirudin administered? IV
How is Bivalirudin administered? IV
What is the half-life of warfarin? 36-42 hours
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
Created by: UVAPATH4



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