coag foundation

TFPI

Tissue factor pathway inhibitor

Heparin sulfate

Blood thinner, inc antithrombin

Thrombomodulin

Modulates thrombin by stopping it, activates protein C

EPCR

Endothelium protein C receptor: works with thrombomudulin to activate protein c decreasing 5 and 8

TPA

Tissue plasminogen factor : precursor to plasmin, eats clots

VWF

bonds to collagen, stabilizes factor 8

Adamts13

Kills vwf multimers

PAI-1 or TPAI-1

Plasminogen activator inhibitor: controls TPA (tissue plasminogen activator) from activating and eventually breaking down clots, blocks TPA until a clot needs to be broken down

TAFI

Thrombin activatable fibrinolysis inhibitor: protects fibrin clot from lysis

TXA2

Thromboxane A2: stimulates plt activation and aggregation

In vitro coag inhibitors

EDTA, citrate, oxalate, heparin

In vivo coag inhibitors

Heparin warfarin

Coagulation COFACTORS

3, 8, 5

Prothrombin/vit K factors

10 9 7 2 C S

Fibrinogen factors

5, 8, 13

Contact factors

11, 12, PK, HMWK

what else does thrombin do

when thrombin is low: aggregates

when thrombin is too high, activates protein C to degrade 5 and 8

PT

Extrinsic pathway

inovin reagent

11-14

Warfarin/oral coumodin affects this test (K factor 7)

PTT

Intrinsic pathway

Actin FSL reagent

23-35

Heparin affects it (factor 8)

A2 antiplasmin/ alpha 2 plasmin inhibitor

Inhibits plasmin

Arterial thrombus

White clots

From wbcs and plts

Activates monos, plts, and macrophages within fatty plaque

Cause of 80% myeloid infarction and strokes

^HS-CRP, homocysteine, lipids , fibrinogen

Venous thrombus

Red thrombi

Damage to EC and RBCs trapped in clot behind valve

Emboli move from legs to lungs

TTC

Thrombin-thrombomodulin complex: involves thrombomodulin which activates EPCR to activate protein CS

Antithrombin

Works with heparin (PTT affected)

Degrades thrombin, 12, 11, 10, 9

Acquired antithrombin deficiency

Decrease in antithrombin levels: from overconsumption

Decrease in antithrombin = more clots

Liver disease (no liver, no antithrombin)

Nephrotic syndrome (antithrombin leak in urine)

Prolonged heparin use (too much heparin is bad)

DIC

Congenital antithrombin deficiency

90% Type 1: low amount

10% Type 2: not functional

Lupus anticoagulant

Ab that binds to phospholipids: causes clots to form

Factor 5 Leiden

Protein C resistance

Glutamine for arginine mutation, prevents factor 5 from being degraded, clots form

Prothrombin G20210A mutation

G2A = guanine to adenine

Actually increase prothrombin

Which increase thrombin = more clots

Increases VENOUS thrombosis

Markers for thrombosis

HS-CRP (predicts cardiovascular disease risk)

Homocysteine (arterial damage and plaque, also seen in def B12)

Fibrinogen (inc in fibrinogen and cholesterol, inc risk)

Antiphospholipid syndrome

1) Lupus anticoagulant (inc PTT)

2) anticardiolipin

3) anti beta 2 glycoprotein

Rheumatoid arthritis, SLE, after bacterial infection/antibiotics