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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
Coagulation Cascade - Actions of Anticoagulants
 • Heparin: Unfractionated heparin, Enoxaparin, Daltaparin
 • Fondaparinux
 • Direct
Coagulation Cascade ... - Actions of Anticoagulants ... • Heparin: Unfractionated ... heparin, Enoxaparin ... Warfarin • 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, ... Clotting Time, Thrombin ... Time, Ecarin Clotting
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
Causes of Abnormal PT and/or aPTT
Prolonged Prothrombin Time (PT)
1. Acquired deficiency of FVII
unfractionated heparin ... - Other anticoagulants ... cause e.g. heparin ... drugs e.g. direct thrombin ... inhibitors, 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 ... 100mg/dL) - Heparin
How to Evaluate an Abnormal APTT
Step 1: Is the PT or APTT Artifactually Prolonged?
Step 2: Is
Step 1: Is the PT ... Patient Receiving Anticoagulants ... K Antagonists, Heparin ... , or Direct Thrombin ... Prolonging the PT
Summary of Coagulation Deficiencies
Inherited:
 • Hemophilia A - Deficiency of Factor VIII
 • Hemophilia B -
Summary of Coagulation ... , CF, IBD) • Anticoagulant ... Medications - Heparin ... inhibitors, direct thrombin ... EricsMedicalLectures/ #Coagulation
Bleeding and Bruising - Disorders of Hemostasis - Differential Diagnosis Framework

== Quantitative or Qualitative defect in
inhibitor of a coagulation ... Acquired: • Heparin ... intravascular coagulation ... warfarin, direct thrombin ... deficiency • Anticoagulant
Differential Diagnosis for a Prolonged PT and aPTT
If the PT and the aPTT are both prolonged,
for a Prolonged PT ... Pre-analytical cause (e.g. heparin ... drugs (e.g. direct thrombin ... inhibitors, heparin ... differential #hematology #coagulation