The absolute basics of normal, preventative, and pathologic coagulation & anticoagulation, aimed to medical students and junior surgical residents. PPT available for download at http://jonessurgery.com/coagulation-anticoagulation.

1. Coagulation &
Anticoagulation
Christian Jones, MD, MS, FACS
Johns Hopkins University School of Medicine
http://jonessurgery.com http://christianjones.md on-call@christianjones.md
@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
clot
stasis
injury
hyper-
coagul-
ability
bleed
cold
acidotic
coagulo-
pathic

11. Antithrombotic Medications
Heparin &
LMWH
warfari
n
bivalirudin
&
argatroban
rivaroxaba
n

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

15. Acknowledgements & Copyright
• Slide 3: “Balanced scale of Justice” in the public domain, obtained from
https://commons.wikimedia.org/wiki/File:Balanced_scale_of_Justice.svg 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
https://commons.wikimedia.org/wiki/File:Coagulation_simple.svg#globalusage 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 https://commons.wikimedia.org/wiki/File:Coagulation_full.svg 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 https://commons.wikimedia.org/wiki/File:Coagulation_full.svg on 10/19/2016
• All other work is the sole creation of Christian Jones (on-call@christianjones.md).
• 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.