Hemostasis and Coagulation Management Flashcards
7 cards from real CCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Hemostasis and Coagulation Management flashcards as text
What is the target activated clotting time (ACT) required before initiating cardiopulmonary bypass (CPB)?
Answer: Greater than 480 seconds
An ACT greater than 480 seconds is required before CPB to ensure adequate anticoagulation and prevent clot formation in the circuit.
Which anticoagulant is the standard of care for anticoagulation during cardiopulmonary bypass?
Answer: Heparin
Unfractionated heparin is the standard anticoagulant for CPB because its effect can be rapidly reversed with protamine sulfate and is easily monitored via ACT.
What is the standard initial heparin dose given before cardiopulmonary bypass in cardiac surgery?
Answer: 300 units/kg
300 units/kg of unfractionated heparin is the standard initial dose to achieve adequate anticoagulation for CPB.
Which drug is used to reverse heparin anticoagulation at the conclusion of cardiopulmonary bypass?
Answer: Protamine sulfate
Protamine sulfate neutralizes heparin by forming a stable complex, effectively reversing anticoagulation at the end of CPB.
A patient on chronic warfarin therapy requires emergent cardiac surgery. What is the most appropriate immediate intervention to reverse anticoagulation?
Answer: Give 4-factor prothrombin complex concentrate (4F-PCC)
4-factor PCC provides rapid reversal of warfarin by replacing clotting factors II, VII, IX, and X, which is critical in emergency settings when there is no time for vitamin K to take effect.
Which coagulation test best monitors heparin anticoagulation during cardiopulmonary bypass?
Answer: Activated clotting time (ACT)
The ACT is used intraoperatively during CPB because it can be performed at the bedside with whole blood and provides rapid results within the range needed for high-dose heparin monitoring.
Heparin resistance during cardiac surgery is most commonly associated with which condition?
Answer: Antithrombin III deficiency
Antithrombin III (AT III) deficiency causes heparin resistance because heparin exerts its anticoagulant effect primarily by binding and activating AT III to inhibit thrombin and factor Xa.