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Hemostasis, D-Dimer, Higher time = Increased risk for bleeding, Matter of…

- - - - Superficial Vein Thrombosis (SVT)
        
        Superficial vein - Vein near the skin surface
        
        Symptoms
        
        Induration of vein
      - Deep Vein Thrombosis (DVT)
        
        Usually in lower extremities; Upper is rare
        
        Symptoms
        
        Edema
        
        Induration of muscle
        
        Venous distention
      - Symptoms
        
        Tenderness, pain, rubour, warmth, inflammation
    - - Risk Factors
        
        Blood hypercoagulability
        
        From thicker blood
        
        Erythropoiesis stimulating drug
        
        Dehydration
        
        Thicker blood = Higher chances for coagulation
        
        Malnutrition
        
        Lower albumin production
        
        Osmosis
        
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        Oral contraceptives
        
        Polycythemia vera
        
        Venous stasis
        
        From
        
        Varicose veins
        
        Immobility
        
        Weakening of muscles
      - Virchow's Triad
        
        Hypercoagulability state
        
        Increased fibrin production
        
        Results to
        
        Platelet aggregation
        
        Thrombus formation
        
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        Fibrin production stimulated by clotting factors
        
        Entrapment by fibrin
        
        Endothelial Damage
        
        Release of clotting factors
        
        Platelet activation
        
        Venous stasis
        
        Pooling of blood
  - - - Indirect Thrombin Inhibitors
        
        Heparin
        
        Fast onset, short duration
        
        Route: IV, subQ
        
        Antidote: Protamine
        
        MOA: Activates anti-thrombin
        
        Prevents conversion of prothrombin into thrombin = prevents fibrinogen into fibrin
        
        Coz thrombin activates fibrinogen into fibrin
        
        Interventions: Blood studies (aPPT), hypersensitivity (HIT), BP, Bleeding
        
        Enoxaparin
        
        Just like Heparin
      - Vit. K inhibitor
        
        Warfarin
        
        Route: PO
        
        MOA: Inhibits hepatic synthesis of vit. K-dependent coagulation factors
        
        Interventions: Blood studies (INR, PT), bleeding
        
        Works intrinsically
        
        Slow onset, prolonged duration
        
        Antidote: Vit. K
      - Slow down clotting by preventing activation
    - - NSAID
        
        Aspirin
        
        MOA: Blocks COX 1
        
        Route: PO
        
        Interventions: Hepatic studies, renal studies, blood studies (PT)
      - ADP Inhibitors
        
        Clopidogrel
        
        MOA: Inhibits ADP induced platelet aggregation
        
        Route: PO
        
        Interventions: TTP, Bleeding, Hepatic studies, Blood studies (PT)
      - Prevents direct platelet aggregation
    - - Tissue Plasminogen Activator (tPA)
        
        Plasminogen converts into plasmin = Breaks down fibrin
- - - - Leads to hemostasis
    - - INR
        
        International Normalized Ratio
        
        Standardized way of reporting PT
      - PT
        
        How many sec it takes to clot via extrinsic pathway
  - - - aPTT
        
        Activated Partial Thromboplastin Time
        
        How many sec it takes to clot via intrinsic pathway
- - - - Acquired
        
        Non-immune
        
        Acquired Thrombo-cytopenic from Decreased Platelet Formation
        
        Pathophysiology
        
        Underlying cause
        
        Bone marrow suppression
        
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        Chemotherapy, disease
        
        Treatment
        
        Corticosteroid
        
        Platelet transfusion
        
        Heparin Induced Thrombo-Cytopenia with Thrombosis (HIT / HITT)
        
        Pathophysiology
        
        HITT
        
        Formation of antigen-antibody complex
        
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        Treatment
        
        Thrombin inhibitors
        
        Warfarin
        
        Thrombolytic
        
        Discontinue heparin
        
        Thrombotic Thrombo-Cytopenic Purpura (TTP)
        
        Pathophysiology
        
        Underlying cause
        
        Platelet aggregation = Platelet Thrombi;
        
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        Ie. Infection, drugs, bacterial toxins
        
        Treatment
        
        Corticosteroid
        
        Identify and treat cause
        
        Chemotherapy
        
        Immune
        
        Immune Thrombo-Cytopenic Purpura (ITP)
        
        Pathophysiology
        
        Platelets are coated with antibodies
        
        Phagocytized by macrophages
        
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        Treatment
        
        Corticosteroid
        
        Treats inflammation
        
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        Platelet transfusion
      - Inherited
    - - Platelets below normal
        
        Abnormal hemostasis
        
        Prolonged bleeding
        
        Spontaneous bleeding without injury
    - - 150 x 10^9
        
        Thrombocytopenia
      - 50 x 10^9
        
        Prolonged bleeding
      - 10 x 10^9
        
        Spontaneous bleedings
        
        Need platelet transfusions
      - Signs of fainting and bleeding = Internal bleeding
    - - Antifibronilytic
        
        Inhibit activation of plasminogen
        
        Inhibit breakdown of fibrin