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Haematology Week 2 2018/19 > 4: Venous thrombosis > Flashcards

4: Venous thrombosis Flashcards

1
Q

.Thrombosis can be either ___ or ___.

A

arterial or venous

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2
Q

What is a common type of venous thrombosis?

What lethal consequence can it have?

A

DVT

Pulmonary embolism

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3
Q

Where do DVTs occur?

Why?

A

Lower limbs

Virchow’s triad

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4
Q

What is the pathophysiology of arterial thrombosis?

A

Atherosclerotic disease

with a background of hypertension, hyperlipidaemia, diabetes….

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5
Q

What are some presentations of arterial thrombosis?

A

Angina

Intermittent claudication

Stroke

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6
Q

Which blood components are involved in arterial thrombosis?

A

Platelets

so prevent with anti-platelets

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7
Q

Apart from starting anti-platelet drugs, what can a patient do to reduce their risk of arterial thrombosis?

A

Modify risk factors through lifestyle

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8
Q

Are platelets involved in arterial thrombosis?

A

Yes

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9
Q

Are platelets involved in venous thrombosis?

A

No

Fibrin - treat with anti coagulants

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10
Q

Which anti-coagulant drugs are used to treat venous thrombosis?

A

Warfarin

Heparin

NOACs

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11
Q

What is Virchow’s triad of venous thrombosis?

A

Endothelial damage

Hypercoagulability

Stasis

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12
Q

What is meant by hypercoagulability?

A

Increased tendency to clot

Blood disorders e.g thrombophilia, polycythaemia

Acute inflammation (clotting factors are acute phase proteins)

Pregnancy (physiological increase in clotting factors)

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13
Q

Which traditional anti-coagulants are used

a) acutely
b) chronically?

A

a) Heparin

b) Warfarin

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14
Q

What are the classic symptoms of a DVT?

A

Warm, swollen, oedematous, painful lower limb

Usually asymmetrical

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15
Q

What are the symptoms of a PE?

A

Pleuritic chest pain

SOB

Haemoptysis

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16
Q

What are the characteristic ECG findings in PE?

A

S1 Q3 T3

17
Q

What are some risk factors for VTE?

A

Increasing age

CVD risk factors

Pregnancy

Hormonal trherapy

Trauma, malignancy, infection, thrombophilia…

i.e VITAMINS ABCDEK

18
Q

In which states do clotting factor levels increase?

A

Obesity

Pregnancy

Hormonal contraception

Infection

Malignancy…

i.e all of them again

19
Q

Which inherited blood disorder greatly increases your chances of developing VTE?

A

Thrombophilia

20
Q

Which protein switches off thrombin and acts as a natural anticoagulant?

A

Antithrombin

21
Q

Apart from antithrombin, which other naturally occuring proteins act as anticoagulants?

A

Protein C and Protein S

Thrombin (with thrombomodulin)

22
Q

Which protein, affected by a common gene mutation, inhibits the activity of Protein C and S?

A

Factor V Leiden

23
Q

What is the risk of VTE in a patient with a Factor V Leiden mutation compared to the general population?

A

5x population average

24
Q

Which anticoagulant proteins are affected by mutations causing thrombophilia?

A

Antithrombin

Protein C and S

Factor V

25
Q

In which groups of patients would you consider screening for inherited thrombophilias?

A

People with VTE aged < 40

People with recurrent VTEs

People with VTEs in weird places

People with family histories of thrombophilia

26
Q

The period after ___ is highest risk for VTE.

A

period after pregnancy

i.e the peurperium

27
Q

Which form of contraception increases a woman’s risk of VTE by 7 times?

A

OCP

28
Q

Risk factors for VTE tend to ___.

A

accumulate

e.g age, immobility, OCP, Factor V Leiden, Fx, Hx over time…

multiplying risk

29
Q

What is the risk of using anticoagulation to prevent or treat VTE?

A

Abnormal bleeding

other end of the spectrum

30
Q

Which autoimmune condition causes acquired thrombophilia?

A

Anti-phospholipid syndrome

31
Q

What condition is APS associated with?

A

Systemic lupus erythematosus (SLE)

Another autoimmune disease

32
Q

What occurs in aPS?

A

Recurrent arterial and venous thrombosis

Recurrent miscarriage

33
Q

What is given to pregnant women with known aPS?

A

Prophylactic heparin (anti-coag) and aspirin (anti-platelet)

34
Q

What are the three important anti-phospholipid antibodies?

A

Anti-B2 glycoprotein

Anti cardiolipin

Anti lupus anticoagulant

35
Q

Which clotting time is prolonged in antiphospholipid syndrome?

A

APTT

36
Q

Which autoimmune disease is associated with aPS?

A

SLE

37
Q

How is aPS treated?

A

Anti-platelet - aspirin

Anti-coagulant - warfarin

life long

modify CVD risk factors

Haematology Week 2 2018/19 (7 decks)

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