44 - Thrombosis and Risk factors for Thrombosis Flashcards

1
Q

Arterial thrombosis

A

Atherosclerosis of vessel wall is usually primary pathological abnormality

Rupture of atheromatous plaques causing endothelial injury

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2
Q

Arterial thrombosis - risk factors

A
Smoking
Hypertension
Hypercholesterolaemia
Anaemia
Family history
Obesity
Physical inactivity
Age 
Male
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3
Q

Venous thrombosis - pathogenesis

A

Venous stasis

Hypercoagulable state

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4
Q

Venous thrombosis - thrombus type

A

Fibrin with a lesser role for platelet accumulation and aggregation

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5
Q

Arterial thrombosis - thrombus type

A

Platelet aggregation and platelet thrombi play an important role in vessel occlusion

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6
Q

VTE - incidence

A

1 per 1,000 pa

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7
Q

VTE - prophylaxis

A

Consistent risk assessment

Appropriate prophylaxis

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8
Q

VTE - treatment

A

Prompt diagnosis

Guideline led unified care

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9
Q

VTE - risk factors

A
Active cancer + cancer treatment
60+
Critical care admission
Dehydration
Known thrombophilias
One or more medical comorbidities
Surgery
Major trauma
Personal history of VTE
HRT
Oestrogen-containing contraceptive therapy
Varicose veins with phlebitis
Obesity 
Pregnancy/post-natal period
Immobility
First degree relative with VTE
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10
Q

Procoaglant - chemicals

A

Platelets

Clotting factors

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11
Q

Anti-coagulant - chemicals

A

Protein C
Protein S
Anti-thrombin III
Fibrinolytic system

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12
Q

Pharmacological prophylaxis

A

Low dose low molecular weight heparin

Fondaparinux

Direct inhibitors of Factor Xa - rivaroxaban

Direct thrombin inhibitors - dabigatran

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13
Q

LMWH treatment

A

Fixed by body weight

Once daily by subcut

Treat for at least 5 days

Overlap with warfarin until INR >2.0 for two days

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14
Q

How much does warfarin dose vary? how does this compare to novel treatment for VTE?

A

Varies 40 fold

vs no need for routine monitoring and standard for each specific population

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15
Q

Thrombophilia definition

A

Familial or acquired disorder of haemostatic mechanism which are likely to predispose to thrombosis.

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16
Q

Heritable thrombothelias

A
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
Activated protein C resistance/FV leiden
Dysfibrinogenaemia
Prothrombin 20210A
17
Q

Acquired thrombophilia

A

Antiphospholipid syndrome

18
Q

Thrombophilia - clinical features

A
DVT
PE
Superficial thrombophlebitis
Thrombosis of cerebral, axillary, portal, mesenteric veins
Arterial thrombosis
Coumarin induced skin necrosis
Obstetric complications (foetal wasted)
19
Q

Factor V Leiden

A

Most common
5-8% European population heterozygous
3-5 fold increase for heterozygous
40 fold increase for homozygotes

20
Q

Prothrombin 20210A

A

Point mutation in 3’ untranslated region of prothrombin gene

Increased prothrombin levels
3 fold increase in venous thrombosis
1-2% occurrence ik UK population

21
Q

Antiphospholipid syndrome

A

Antiphospholipid antibodies present on at least 2 occasions 8 weeks apart in association with venous/arterial thrombosis or recurrent foetal loss