1. Coagulation & Anticoagulation
Christian Jones, MD, MS, FACS
Johns Hopkins University School of Medicine
@jonessurgery

2. Overview
Coagulation
Anticoagulation

3. Coagulation/Anticoagulation

4. Classic Coagulation
Mechanical
Chemical

5. Classic Coagulation - Virchow
clot
stasis
injury
hyper-coagul-ability

6. Classic Coagulation - Factors

7. Real Coagulation Cell mediated, not chemical mediated
Platelets are most important
Platelets form plug (thromboxane)
 fibrin surrounds (classic coagulation)
 RBCs get stuck

8. Real Coagulation - Venous
stasis, injury, hypercoagulability
fibrin, platelets, sticky RBCs

9. Real Coagulation - Arterial
high shear
plaque builds up in media of arteries
plaque ruptures followed by massive platelet activation
typical cell mediated clot forms

10. Pathologic Anticoagulation
bleed
cold
acidotic
coagulo-pathic
clot
stasis
injury
hyper-coagul-ability

11. Antithrombotic Medications
rivaroxaban
Heparin & LMWH
bivalirudin & argatroban
warfarin

12. Antiplatelet Medications
COX inhibitors (ASA)
ADP receptor inhibitors (clopidogrel, prasugrel)
GP IIb/IIIa receptor blockers (abciximab, tirofiban)

13. Summary
Coagulation – model versus real
Anticoagulation – normal, pathologic, prevention
The most common problem leading to postoperative bleeding is silk deficiency.

14. Questions? Comments? Concerns? on-call@christianjones.md @jonessurgery
Thank You
Questions? Comments?

15. Acknowledgements & Copyright
Slide 3: “Balanced scale of Justice” in the public domain, obtained from on 10/19/2016
Slide 6: “Coagulation simple” created by “Joe D” (user Steinsky on Wikimedia Commons), licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license, obtained from on 10/19/2016
Slide 6: “Coagulation full” created by “Joe D” (user Steinsky on Wikimedia Commons) and modified by user Epgui, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license, obtained from on 10/19/2016
Slide 11: “Coagulation full” created by “Joe D” (user Steinsky on Wikimedia Commons) and modified by user Epgui, licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license , obtained from on 10/19/2016
All other work is the sole creation of Christian Jones
As required by the terms of the Creative Commons Attribution-Share Alike 3.0 Unported license, this work is similarly licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.