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Parenteral Anticoagulation Overview and Labs
Pharmacotherapy Fall 2013 Exam 3
18
Pharmacology
Professional
12/01/2013

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Term
endothelial injury
Definition
trauma, tumor, previous DVT/PE, heart valve dx/ replacement, surgery, fractures, catheters, MI, atherosclerosis
Term
hypercoagulable states
Definition
preggers, malignancy, thrombocytosis, estrogen therapy, myloproliferative disorder, protein C/S deficiency, anti-phospholipid antibody syndrome, antithrombin deficiency, factor V leiden
Term
abnormal blood flow
Definition
AFib, bed rest, immobilization/ paralysis, venous obstruction (tumor, obesidy, preggers), left ventricular dysfunction
Term
pulmonary embolism diagnostic tests
Definition
X-ray, V/Q scan, pulmonary angiogram, spiral computed tomography (CT), D-diamer test
Term
d-diamer
Definition
high negative predictive value, used when low clinical probability of DVT or PE ssessed
Term
non-pharmacologic VTE prophylaxis
Definition
intermittent pneumatic compression, graduated compression stockings, leg elevation, lex exercise, early post-op ambulation
Term
frequent aPTT monitoring for heparin
Definition
6h after loading dose, 6h after any change in infusiong; once stable (2 consecutive aPTT target range) and therapeutic--check every 24 hours
Term
activated clotting time (ACT)
Definition
used with large doses of heparin exceeding plasma concentrations of >1 unit/mL
Term
other labs for heparin monitoring
Definition
ACT, antifactor Xa activity, plasma heparin concentrations
Term
plasma heparin concentrations
Definition
used to establish therapeutic aPTT's in institutions or in patients with unreliable aPTTs
Term
thrombocytopenia with heparin
Definition
HAT,HIT, and HITT
Term
heparin induced thrombocytopenia
Definition
5-14 days, re-exposure may result in earlier onset, decreased RBC's by 50% from baseline, very low platelet counts rare
Term
other causes of thrombocytopenia
Definition
sepsis, perioperative hemodilution, other drug-induced, non-immune mediated HAT
Term
direct thrombin inhibitors
Definition
argatroban, bivalirudin (Angiomax), lepirudin (Refludan), desirudin (Iprivask)
Term
ACCP recommends against VKA therapy in HIT patients
Definition
until after the platelent count has substantially recovered to at least 150,000
Term
ACCP recommends that VKA therapy in HIT patients be started
Definition
only with low, maintenance doses rather than with high initial doses
Term
ACCP recommends that non-heparin anticoagulants should be
Definition
continued until the platelet counthas reached stable plateau (INR reached intended target range), and an overlap period has occured with VKA therapy
Term
ACCP recommends the use of Vit K (10mg po or 5-10 mg IV)
Definition
in patients receiving VKA therapy at the time of diagnosis of HIT
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