Episode 3 - Waiting for Clot(-o) | Prolonged Clotting Times and Anticoagulants

05/28/24 • 47 min

“Have you not done tormenting me with your accursed time?“ Senior scientists Vladimir and Estragon are waiting quite a while for a clot to form in their tube. How should you react to prolonged clotting times? We cover an approach to prolonged PT and aPTT, as well as discuss the mechanism of common anticoagulants and their impact on these basic tests.
Timestamps
00:00 - Intro
01:22 - Episode 2 Recap
03:13 - Why clotting times prolong
05:38 - Short clotting times
07:00 - Platelets and clotting times
08:00 - Introduction to Anticoagulants
10:25 - Unfractionated Heparin
17:04 - Low Molecular Weight Heparins
20:20 - Fondaparinux
21:37 - Vitamin K "Inhibitors"
27:55 - Direct Oral Anticoagulants
33:04 - Anticoagulants Recap
34:10 - An approach to long clotting times
35:58 - Cases
45:45 - Takehomes

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Previous Episode

Episode 2 - In the Lab: PT and aPTT

It is a truth universally acknowledged that a JMO in possession of a coagulation tube will underfill it. But why should it matter?! In this episode, we review the principles behind the two most important coagulation screening tests (The PT and the aPTT) as well as follow the journey of that precious citrated sample through the lab. By the end, you’ll know enough to at least feel guilty when you still send that half filled tube down the chute at 3am
Timestamps:
00:00 - Introductions
01:40 - Clinical Case
03:29 - Development of coagulation testing
06:05 - Why you need to fill the tube
09:40 - Removing platelets
13:30 - Coagulation Profile and the INR
14:51 - The PT
20:32 - The aPTT
27:00 - Summary

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au

Next Episode

Episode 4 - Forever Alone: The Isolated Prolonged aPTT

Being alone can be difficult - and we would know! How should we think about a long aPTT when the rest of the coag screen looks normal? Join Bloody Minded crew as we learn how to tackle this surprisingly common (and surprisingly tricky) problem.
Timestamps
00:00 - Introductions
02:21 - aPTT Revision
03:59 - A case
08:04 - Testing for heparins
10:10 - Back to the case
11:10 - DOACs and the aPTT
12:34 - Mid Episode Recap
13:32 - What if not heparin?
16:56 - Mixing studies
21:11 - PT Mixing
23:01 - Case returns
24:17 - Summary

Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au