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Coagulation cascade and anticoagulants 

Satyendra Dhar MD, @DharSaty

#coagulation #coumadin #heparin #warfarin #apaxiban #pradaxa #xarelto #DOAC #vWF
Coagulation cascade ... and anticoagulants ... #coumadin #heparin ... xarelto #DOAC #vWF #thrombin ... #ptt #pt
How to Evaluate an Abnormal APTT
Step 1: Is the PT or APTT Artifactually Prolonged?
Step 2: Is
to Evaluate an Abnormal ... the PT or APTT ... Patient Receiving Anticoagulants ... K Antagonists, Heparin ... , or Direct Thrombin
Effect of Anticoagulants on Coagulation Tests
PT / INR, aPTT, Anti-Xa Activity, Activated Clotting Time, Thrombin Time,
Effect of Anticoagulants ... on Coagulation ... Tests PT / INR, ... aPTT, Anti-Xa Activity ... EricsMedicalLectures/ #Anticoagulants
Causes of Abnormal PT and/or aPTT
Prolonged Prothrombin Time (PT)
1. Acquired deficiency of FVII
Causes of Abnormal ... PT and/or aPTT ... - Other anticoagulants ... drugs e.g. direct thrombin ... #PT #aPTT #Prolonged
Bleeding and Bruising - Disorders of Hemostasis - Differential Diagnosis Framework

== Quantitative or Qualitative defect in
PT/NORMAL PTT: ... PT/ABNORMAL PTT ... PT/NORMAL PTT: ... PT/ABNORMAL PTT ... deficiency • Anticoagulant
The coagulation cascade is shown, separated into different phases with their endogenous and pharmacological inhibitors shown.
The coagulation ... at the site of injury ... #clot #PT #PTT ... anticoagulation #anticoagulant ... Rivaroxaban #Edoxaban #heparin
Disseminated Intravascular Coagulation (DIC) Overview

Increased Clotting and Consumption of Clotting Factors

Findings:
 • Bleeding
 • Recent history
• Prolonged PT ... • Increased thrombin ... Fibrinogen: ↓ • PT ... Reduction of pro/anticoagulants ... INR < 2.3 - APTT
Differential Diagnosis for a Prolonged PT and aPTT
If the PT and the aPTT are both prolonged,
PT and the aPTT ... drugs (e.g. direct thrombin ... amyloidosis #Abnormal ... #PT #aPTT #Prolonged ... differential #hematology #coagulation
Effect of Direct Oral Anticoagulants on Hemostatic Tests
Horizontal bars correspond to the approximate range of detectability
of Direct Oral Anticoagulants ... within and above typical ... assay; ECT = ecarin ... clotting time; TT = thrombin ... laboratory #testing #aptt
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
AST/ALT > ALP: Typical ... - If both are normal ... • Albumin • Coagulation ... factors: PT/INR ... replaced by non-hepatic