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Moag Canagement

Coagulation Management

QuestionAnswer
Intrinsic Pathway activation Contact activation involves binsding of Factor XII to negatively charged surfaces which further leads to activation of common pathway
Pathway that is more important in Cardiac Surgery: Intrinsic pathway as it provides access for heparin monitoring and neutralization
Extrinsic pathway initiation Tissue factor initiates extrinsic pathway with the aid of Factor VII and calcium
Importance of Thrombin (Positive feedback effect) Provides positive feedback by activating cofactors V and VIII
Importance of Thrombin: Activates cross-linking of fibrinogen by activating factor XIII
Importance of Thrombin: Stimulates platelet adhesion and aggregation
Importance of Thrombin: Facilitates clot resorption by releasing tpa from endothelial cells
Importance of Thrombin (Negative feedback effect) Activates protein C which provides negative feedback by inactivating factors Va and VIIIa
Potent stimuli for platelet activation: Thrombin
Substance essential for Platelet adhesion: Von Willebrand factor (vWF)
Substance essential for platelet aggregation: Fibrinogen
Products released from platelet storage granules that perpetuate platelet activation: ADP, Epinephrine, Calcium, Thromboxane A2, Factor V and vWF
Nature's way to counterbalance clot formation inside the body: 1. Protein C and S 2. ATIII 3. Tissue factor inhibitor 4. tPA
Increase in fibrinogen and D-Dimer values indicate: Fibrinolysis
Laboratory tests to monitor heparin aPTT or ACT
Laboratory tests to monitor LMWH anti-Xa test
Laboratory tests to monitor Warfarin PT and INR
Laboratory tests to monitor platelet inhibitors including aspirin Bleeding time and platelet function tests
Heparin resides physiologically in: Mast cells
Commercial sources of heparin Lungs of cattle or pig intestines
Mean molecular weight of heparin 15,000 Daltons
Heparin - acid/base Heparin is a strong biologic acid that is negatively charged at physiologic pH
Action of heparin Heparin binds to ATIII and potentitiates its action by 1000 fold
Heparin inhibits factors: IXa, Xa, XIa and XIIa
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