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
The protamine-to-heparin reversal ratio most commonly used in clinical practice is:
Answer: 1 mg protamine per 100 units of heparin
The standard reversal ratio is 1 mg of protamine sulfate per 100 units of heparin administered, though adjustments are made based on elapsed time since heparin dosing.
During CPB, a patient's ACT is measured as 600 seconds. The surgeon requests that anticoagulation be decreased. What is the correct response?
Answer: No action needed; wait for heparin metabolism
During CPB, a very high ACT is generally well tolerated and does not require intervention; heparin will naturally metabolize over time.
Which of the following factors does NOT directly prolong the ACT in a patient on CPB?
Answer: Elevated fibrinogen levels
Elevated fibrinogen levels do not prolong the ACT; hemodilution, hypothermia, and thrombocytopenia all independently prolong clot formation time measured by ACT.
After coming off CPB, the patient has a chest tube output of 400 mL/hour of bright red blood. The ACT is 128 seconds (baseline 120 s). TEG shows normal clot strength. What is the most likely cause of bleeding?
Answer: Surgical bleeding from an unligated vessel
Normal ACT and TEG with bright red surgical bleeding strongly suggest a mechanical/surgical source rather than a coagulopathy.
In the context of CPB anticoagulation, what does 'heparin dose-response curve' refer to?
Answer: A plot of ACT versus heparin concentration used to guide supplemental dosing
The heparin dose-response curve plots baseline and post-heparin ACT values against heparin dose to predict the dose needed to achieve and maintain target ACT during CPB.
A perfusionist notices that the oxygenator's fiber bundle appears clotted 45 minutes into CPB. The last recorded ACT was 480 seconds 30 minutes ago. What should be done immediately?
Answer: Check the ACT and administer additional heparin if below target
Oxygenator clotting suggests possible inadequate anticoagulation; the ACT should be immediately checked and additional heparin administered if below the target threshold.
Which statement regarding argatroban as a CPB anticoagulant in HIT patients is correct?
Answer: Argatroban is a direct thrombin inhibitor with no specific reversal agent
Argatroban is a direct thrombin inhibitor with no specific reversal agent; it is hepatically metabolized, making it preferable in renal but not hepatic failure.