Antiplatelet Antithrombotic and Thrombolytic Agents

Antiplatelet Antithrombotic and Thrombolytic Agents
Antiplatelet Antithrombotic and Thrombolytic Agents
1 Which of the following factors associated with
coagulation is not released from activated platelets?
(A) Fibrinogen
(B) Adenosine diphosphate (ADP)
(C) Tissue plasminogen activator (tPA)
(D) Plasminogen activator inhibitor-1 (PAI-1)
(E) Platelet factor 4 (PF4)
2 In the GUSTO-I (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded
Arteries) trial, ischemic events and bleeding events
were correlated with the activated partial thromboplastin time (aPTT) 12 hours after heparin therapy
was initiated. The investigators described an optimal therapeutic range for aPTT where the risk of
death and moderate or severe bleeding was lowest.
This range (from point a to point b in the following
figures) was found to be:
19%
17%
15%
13%
11%
9%
7%
5%
a b
aPTT (seconds) after 12 hours
Probability of
moderate or severe bleeding
A
a b
aPTT (seconds) after 12 hours
a b
aPTT (seconds) after 12 hours
Probability of
hemorrhagic stroke
1.0%
0.8%
0.6%
0.4%
0.2%
0.0%
Probability
of death
8%
6%
4%
2%
0%
B
C
Circulation. 1996;93:870–878.
(A) 40 to 60 seconds
(B) 50 to 70 seconds
(C) 70 to 90 seconds
(D) None of the above
3 Pharmacotherapies known to reduce the occurrence
of death or myocardial infarction (MI) among
32
Antiplatelet, Antithrombotic, and Thrombolytic Agents 33
patients with non–ST-segment elevation myocardial
infarction (NSTEMI) include all of the following,
except:
(A) Aspirin
(B) Clopidogrel
(C) Unfractionated heparin
(D) Low-molecular-weight heparin
(E) IIb/IIIa antagonists
(F) Fibrinolytic agents
4 Unfractionated heparin affects several factors in the
coagulation cascade. What is the effect of heparin on
levels of tissue factor pathway inhibitor (TFPI)?
(A) Increased
(B) Unchanged
(C) Decreased
5 Which of the following statements is false concerning
IIb/IIIa inhibitors?
(A) Bleeding is infrequent although it usually occurs
in hollow organs (gastrointestinal, genitourinary, and vascular)
(B) Severe thrombocytopenia occurs in approximately 1% of patients
(C) Thrombocytopenia is more frequent with abciximab, especially with early repeat administration
(D) Thrombolysis in myocardial infarction (TIMI)
major bleeding is increased by approximately
1% when using a IIb/IIIa inhibitor, and this is
predominately due to an increase in intracranial
hemorrhage
6 A 47-year-old white man was found to have a positive
stress test result on preoperative evaluation. He
underwent successful implantation of a drug-eluting
stent (TAXUS) into the left anterior descending
coronary artery. Approximately 6 weeks later, you
are contacted by the patient’s orthopaedic surgeon
who wishes to proceed with a planned knee surgery.
Your recommendations are:
(A) Proceed with planned surgery, but discontinue
clopidogrel at least 5 days in advance
(B) Admit the patient to hospital, discontinue
clopidogrel, and begin intravenous eptifibatide
(C) Discontinue clopidogrel and after 2 days admit the patient to hospital for fondaparinux
injections
(D) Postpone surgery for at least 4 months
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