There’s an entire coagulation cascade going on in your blood vessels that is protecting you from bleeding to death. It’s complex process, and it’s easy to get lost in the intricacies of the mechanism. Lucky for us, Dr. Stephanie Woodruff, Program Director at Ursuline College Nurse Anesthesia Program joins us in this episode to give us an easier way to memorize how the coagulation cascade works. Get your notes and tune in!
Stephanie Woodruff, DNP, CRNA, CHSE
Nurse Anesthesia Program Director (NAPD)
Associate Professor
Dr. Woodruff serves as the Program Director of SNAP. She graduated from Georgetown University in 1994 with a bachelor’s in nursing. In 1998, she received her master’s in nursing from the University of Pennsylvania and was certified as a Nurse Practitioner in Women’s Healthcare. Dr. Woodruff became a Certified Registered Nurse Anesthetist in 2008 after graduating with her second master’s degree from the University of Pennsylvania. In 2017, she received her DNP from Wilmington University. She is the State Peer Advisor for Pennsylvania through the AANA and is a member of the Pennsylvania Association of Nurse Anesthetist Wellness Committee. Dr. Woodruff continues to practice clinically once a week.
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The Coagulation Cascade: An Easy Way To Memorize By Dr. Stephanie Woodruff, Program Director At Ursuline College Nurse Anesthesia Program
In this episode, we have the privilege of welcoming Dr. Stephanie Woodruff from the Ursuline College Nurse Anesthesia Program, where she serves as the Program Director. She graduated from Georgetown University in 1994 with a Bachelor’s in Nursing. In 1998, she received her Master’s in Nursing from the University of Pennsylvania and was certified as a nurse practitioner in women’s healthcare.
Dr. Woodruff became a certified registered nurse anesthetist in 2008 after graduating with her second Master’s degree from the University of Pennsylvania. In 2017, she received her DNP from Wilmington University. She also serves as a State Peer Advisor for Pennsylvania through the ANA and is a member of the Pennsylvania Association of Nurse Anesthetist Wellness Committee. She also practices clinically.
Dr. Woodruff will be diving into an essential topic that can be hard to master. It’s the clotting cascade. This complex system plays a critical role in how our bodies control bleeding and heal after injury. Get ready to uncover the layers of this intricate process with Dr. Woodruff’s expert guidance. Whether you’re a nursing student starting your journey or a seasoned nurse anesthesia resident, brushing up on your knowledge, this episode is packed with viable insights you won’t want to miss. Let’s go ahead and get started.
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The Coagulation Cascade Simplified
My name is Dr. Stephanie Woodruff. I am the Program Director at Ursuline College with SNAP, based out of Pepper Pike, Ohio. I’m going to talk to you about the coagulation cascade. This is a complex subject that I’m going to make simple, and this is how it was taught to me. The coagulation cascade is an important topic to understand how the body clots, but it’s also on your CRNA boards. Let’s say you cut your hand on an apple. It hurts. You are bleeding. You grab a towel. Two minutes later, you stop bleeding. How did that happen? There’s an entire coagulation cascade going on in your blood vessels that is protecting you from bleeding death. Here is a simple way to understand the coagulation.
Before I begin, I must give credit to my professors who taught me this. This is a brilliant way to memorize the coagulation cascade. I want you to get a piece of paper out and write down number twelve all the way to the left and number one. All the numbers climb down the ladder. Write the number ten in the middle and put a star around it. This is factor ten. This is where the party is. Everything is connected to factor ten.
Write down 11 next to 12, and you skip to nine. I know this is odd, but you already wrote down the number ten. If you switch the two in your brain, it’ll make more sense. What is between factors 9 and 10? You guessed it. Number eight. Let’s count down, 12, 11, 10, 9, 8. Put factor 2 between 10 and 1. Add factor five up the top. If you practice this sequence over again, it will stick in your head.
Write seven below ten and draw a little cloud right here. You drew a circle around 9, 7, 10, and 2. This will make more sense in the next slides. Remember the cloud you drew around 9, 10, 2, and 7. I want you to draw a right here. This is extrinsic pathways 9, 10, 7, and 2. I want you to draw a line all the way across. This is the intrinsic pathway, 12, 11, 9, 8, 10, 5, 2, and 1.
Here’s a tissue factor. The tissue factor must be activated to go seven, which converts to factor ten, which converts to 2 and 5. Two is converted to one. You understand which factors are intrinsic pathways, which is your cloud right here, 9, 10, 2, and 7, and what is the intrinsic pathway all the way across 12, 11, 9, 8, 10, 5, 2, and 1. You need factor eight to convert 9 to 10. You need factor five to convert 10.
Getting Vitamin K
I’m going to talk about the extrinsic pathway. Remember when we drew this with the extrinsic pathway 9, 7, 10, and 2? The extrinsic pathway is connected to warfarin. The extrinsic pathway is vitamin K-dependent. How do we get vitamin K, or how do we produce it? Normally, we produce it in the bacteria in our gut, or we eat green leafy vegetables. Vitamin K is stored in the liver. If your liver is not working properly or you do not have bacteria in your gut, you’ll be vitamin K deficient.
If your liver is not working properly or if you do not have bacteria in your gut, you'll be Vitamin K deficient. Click To TweetVitamin K is activated by an enzyme called epoxide oxidase, which activates vitamins to which factors 10, 9, 7, and 2. I put a one and a little zero here because vitamin K was born in 1972. If you put the one and the zero together, it’s 10, 9, 7, and 2. It’s the same thing. To prevent clotting of the blood, warfarin is prescribed. Warfarin prevents epoxide oxidase from activating vitamin K, and vitamin K does not activate these factors, 10, 9, 7, and 2. If they’re not activated, there is no clot.
For example, patients who have atrial fibrillation are put on warfarin to prevent clotting. Labs that are ordered to see if warfarin is working, PT/INR. If you remember, the extrinsic pathway, warfarin, and PT/INR. For the intrinsic pathway to work, you need all of these factors to block this pathway. Heparin is prescribed.
What is interesting is that heparin helps antithrombin down here to inhibit factors 12, 11, 9, and 10. To see if heparin is working, PTT is ordered. If you put a little dash between the two Ts, it becomes an H. This is important because if a patient is in the hospital and has a DVT in the leg, they’re put on heparin to prevent them from throwing a clot into the lungs and brain. Heparin is important. Finding if heparin works, you order PTT. Finding if warfarin works, you order PT/INR.
Is it making more sense? I’m sure you’re thinking by now, “Where do all these coagulation factors come from?” All of the factors are produced in the liver except for factor eight and Von Willebrand factor. The WF eight and Von Willebrand factor are always together. They’re married. Remember the first drawing we did? You need factor eight to convert 9 and 10. You need factor five to convert from 10 to 2, and 2 activates 1.
All of these factors are produced in the liver except for factor 8 and prothrombin factor. Factor two is called prothrombin. Factor two is converted to factor one. Factor one is called fibrinogen and is converted into fibrin with the help of calcium. Fibrinogen is the primary plug. With the help of calcium, fibrin is a secondary hemostatic. Fibrin is a stable clot, which is the ultimate goal.
As you can see, the coagulation cascade is important to the body. You understand the clouding cascade. Each time you cut yourself, you know how the clot is formed. When your liver’s not working properly, neither is the coagulation cascade. Thank you for reading my presentation on the coagulation cascade. I hope you enjoyed it and you understand it better.
I am the Program Director of the Ursuline College Nurse Anesthesia Program with SNAP. This is based outta Pepper Pike, Ohio. It is a 36-month format that prepares a baccalaureate-educated nurse to become a doctoral prepared nurse. Classes will be asynchronous and synchronous for the distance learning program. Students will be required to be on campus once a year throughout the three-year program for intensive skills construction and competency assessments.
This is a national program with clinical sites across the United States. Clinical starts in year two. Our applications are now open for the next cohort that starts in January 2025. The application deadline is May 15th, 2024. Visit our website at SNAPCRNA.com to register for more information or information sessions. Our next information section is on March 12th, 2024. We have them at least twice a month up until May 2024. I look forward to seeing you. Thank you for your time.
Important Links
FREE! CRNA School Interview Prep Guide: https://www.cspaedu.com/uc9a5ih4
Fast-Track Your CRNA Interview Prep with our CRNA Interview Crash Course! https://www.cspaedu.com/4wotmlds
Have you gained acceptance to CRNA school? Congratulations! Prepare with the #1 pre-anesthesia curriculum, as recommended by CRNA program faculty. Start the NAR Boot Camp today: https://www.cspaedu.com/bootcamp
Thousands of nurses have gained CRNA school acceptance with CRNA School Prep Academy. Join today for access to all of the tools proven to accelerate your CRNA success! Click here:
Join the CSPA email list: https://www.cspaedu.com/podcast-email
Join the Free Facebook Community here! https://www.facebook.com/groups/crnaschoolprepacademyfree
Book a mock interview, resume or personal statement critique, transcript review and more: www.teachrn.com
