CVP Coagulation and Anticoagulation Management 2

Question 1

Which antifibrinolytic agent acts as a broad serine protease inhibitor, directly inhibiting plasmin, kallikrein, and thrombin?

Accepted Answer

Aprotinin

Answer

Tranexamic acid

Answer

Epsilon-aminocaproic acid (EACA)

Answer

Desmopressin (DDAVP)

Question 2

On a TEG (thromboelastography) tracing, the Maximum Amplitude (MA) primarily reflects:

Accepted Answer

Platelet function and platelet-fibrin clot strength

Answer

Thrombin generation speed

Answer

Fibrinolytic activity rate

Answer

Coagulation factor concentration

Question 3

A post-CPB patient has persistent microvascular bleeding with markedly reduced fibrinogen on ROTEM. The most appropriate blood product is:

Accepted Answer

Cryoprecipitate

Answer

Fresh Frozen Plasma (FFP)

Answer

Platelets

Answer

Packed Red Blood Cells (pRBCs)

Question 4

Tranexamic acid reduces surgical blood loss primarily by:

Accepted Answer

Competitively blocking lysine-binding sites on plasminogen

Answer

Inhibiting thrombin generation via the intrinsic pathway

Answer

Increasing platelet aggregation via ADP receptors

Answer

Activating Factor XIII cross-linking

Question 5

Which coagulation factor is most significantly reduced by hemodilution and consumption during cardiopulmonary bypass?

Accepted Answer

Factor I (Fibrinogen)

Answer

Factor V

Answer

Factor VIII

Answer

Factor XII

Question 6

The intrinsic coagulation pathway is initiated by:

Accepted Answer

Contact activation of Factor XII on negatively charged surfaces

Answer

Tissue factor binding to Factor VIIa

Answer

Thrombin-mediated positive feedback on Factor V

Answer

Collagen-induced platelet activation releasing ADP

Question 7

In a patient with known HIT antibodies requiring urgent cardiac surgery, which anticoagulant is most appropriate for CPB?

Accepted Answer

Bivalirudin (a direct thrombin inhibitor)

Answer

Low molecular weight heparin (LMWH)

Answer

Unfractionated heparin at double the standard dose

Answer

Fondaparinux