Coagulation Panel
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What is included in the tube used to collect blood for a coagulation panel and why?
Citrate Stops blood clotting in the tube
What 4 things are measured in a coagulation panel?
PT, APTT, Fibrinogen, INR
What is PT?
Prothrombin time /s
What is APTT?
Activated partial thromboplastin time /s
What is fibrinogen measured in?
g/L
What is INR and what is it used for?
an internationally standardised ratio based on PT, technically only valid for warfarin
What part of the blood is used to measure the clotting time?
Platelet-poor plasma
What is the intrinsic pathway order?
XII -> XI -> IX -> VIII -> X
What is the extrinsic pathway order?
VII -> X
What is the common pathway order?
X -> Xa Prothrombin (FII) -> Thrombin (FIIa) Fibrinogen (FI) -> Fibrin clot
What are DOACs?
Direct-acting oral anticoagulants
Which clotting factor do apixaban, rivaroxaban and edoxaban act on?
Factor X
Which clotting factor does Dabigatran work on?
Thrombin
How do DOACs affect coag panel tests?
Variable non-linear impact on PT and APTT
What coagulation factors does warfarin inhibit?
IX, VII, X, Prothrombin (II)
How does warfarin work to inhibit coagulation factors?
Inhibits the synthesis of vitamin K dependent clotting factors
What else does warfarin inhibit the synthesis of?
Protein S and C
How does warfarin affect coagulation panels?
Affects PT and APTT PT is particularly sensitive - INR used to monitor dosage
What are heparins?
naturally occuring sulphated glycosaminoglycans isolated from animal tissue - usually porcine intestine
How do heparins inhibit blood coagulation?
Potentiating the effect of antithrombin Accelerates the inactivation of thrombin and factor Xa
What can unfractionated heparin bind to?
antithrombin and thrombin
How is unfractionated heparin administered?
Intravenously Loading dose required before continuous infusion Careful monitoring needed
What does low molecular weight heparin bind to?
Antithrombin
How is low molecular weight heparin administered?
Subcutaneous injection Weight dependent dosage