Hypercoaguable States

1 month 2-3 months

Recurrent venous thromboembolism Acute arterial thromboembolism (1 month) Mechanical heart valve Atrial fibrillation

Table 3.6.Medications affecting coagulation

Class

Example

Effects

Comments

Aspirin

Heparin

Antiplatelet Clopidogrel (Plavix), agents cilostazol (Pletal)

Heparin

Warfarin Coumadin

Lepirudin Refludan

DDAVP Desmopressin

Aprotinin Trasylol

Platelet inhibitor, irreversible. 7 days

Platelet aggregation inhibitor, inhibits cellular phosphodiesterase Binds antithrombin III

Inhibits vitamin K dependent enzymes Directly inhibits thrombin

Increases factor VII levels, increases release of vWF

Serine protease inhibitor; inhibits plasmin, tPA and serum urokinase plasminogin activator

DDAVP has some success in reversal. Platelet transfusion Discontinue 7 days before major surgery

Stop 4 hours prior to surgery. Must follow PTT. Watch for HIT Need 4 days to reverse

Heparin substitute for HIT

Transient response

Decreases bleeding after cardiopulmonary bypass

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