Anticoagulation & Heparin Management Flashcards
7 cards from real CCP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Anticoagulation & Heparin Management flashcards as text
A patient develops heparin-induced thrombocytopenia type II (HIT II) prior to elective CABG. Which anticoagulant is most appropriate for CPB?
Answer: Bivalirudin
Bivalirudin is the preferred alternative anticoagulant for CPB in HIT II patients because it directly inhibits thrombin without cross-reactivity to heparin-PF4 antibodies.
What is the primary disadvantage of using bivalirudin as an anticoagulant during CPB compared to unfractionated heparin?
Answer: No reversal agent is available
Unlike heparin, which can be reversed by protamine, there is no specific reversal agent for bivalirudin, which poses challenges if rapid anticoagulation reversal is needed.
Which laboratory test is used to diagnose heparin-induced thrombocytopenia type II (HIT II)?
Answer: Heparin-PF4 antibody assay (ELISA) and serotonin release assay (SRA)
HIT II diagnosis combines an immunological test (ELISA for heparin-PF4 antibodies) and a functional assay (SRA) to confirm platelet-activating antibodies.
After CPB, a patient receives 350 mg of protamine to neutralize heparin. The ACT remains elevated at 180 seconds (baseline 120 s). What is the most appropriate next step?
Answer: Administer additional protamine
A persistently elevated post-protamine ACT suggests inadequate heparin reversal, and additional small doses of protamine (25–50 mg) should be administered.
Which of the following best describes 'heparin rebound' after cardiac surgery?
Answer: Re-elevation of ACT hours after protamine reversal due to heparin re-entering circulation from tissue depots
Heparin rebound occurs when heparin sequestered in tissue depots re-enters the systemic circulation hours after protamine reversal, causing re-anticoagulation.
During protamine administration for heparin reversal, the patient develops sudden hypotension and bronchospasm. What is the most likely cause?
Answer: Anaphylactic or anaphylactoid protamine reaction
Protamine can trigger anaphylactic or anaphylactoid reactions, particularly in patients with fish allergies or prior protamine exposure (e.g., NPH insulin users).
What effect does excess protamine have on coagulation?
Answer: Acts as an anticoagulant by inhibiting thrombin
Excess protamine itself has anticoagulant properties by directly inhibiting thrombin and platelet function, paradoxically worsening coagulopathy.