Arterial Thrombosis and VTE Flashcards
What is an arterial thrombi?
When a thrombus forms within an artery, this is known as an arterial thrombosis
What is clot formation typically triggered by?
the rupture of an atherosclerotic plaque, a highly thrombotic event, with platelets rapidly recruited to the site.
What slowly increases as the thrombus extends into the arterial lumen?
The fibrin content
Thus, an arterial thrombus is typically platelet-rich, fast growing, and exposed to fast blood flow
What do AF- related thrombi closely resemble?
AF-related thrombi are also categorized as arterial clots, but more closely resemble ‘venous-type’ clots, fulfilling Virchow’s triad for thrombogenesis
AF-related thrombi form in low-flow, low-pressure environments, producing slow-growing, fibrin-rich clots
What are the risk factors for arterial thrombosis?
Smoking
Obesity
High blood pressure
Increased levels of cholesterol
Diabetes
Increasing age
Family history
Physical inactivity
Increased concentrations of blood coagulation factors
Blood serum lipid abnormalities
What can cause plaques to rupture?
Inflammation of arterial lining which exposes tissue factors, triggering clotting mechanisms and platelets
What two categories can arterial thrombosis be put into?
- Coronary thrombosis
- Cerebral thrombosis
What might a coronary thrombosis materialise into?
MI
What might a cerebral thrombosis materialise into?
Stroke
What are the typical diagnosis techniques for arterial thrombosis?
- Angiography
- Ultrasound
What is atherosclerosis?
Combination of fatty deposits and hardening of artery walls.
What are the non-modifiable risk factors for atherosclerosis? (3)
- Older age
- Family history
- Male
What are the modifiable risk factors for atherosclerosis? (8)
raised cholesterol, smoking, alcohol consumption, poor diet, lack of exercise, obesity, poor sleep, stress
What comorbidities can lead to atherosclerosis? (5)
Diabetes, hypertension, chronic kidney disease, inflammatory conditions, atypical antipsychotic medications.
What is the pathophysiology of atherosclerosis?
Chronic inflammation and immune system activation in artery walls, leading to lipid deposition and development of fibrous plaques.
What are the complications of atheromatous plaques? (3)
Stiffening (hypertension), stenosis (angina), plaque rupture (ACS due to thrombosis).
What are the systemic complications of atherosclerosis? (4)
Stroke/TIA, MI/angina, chronic mesenteric ischaemia, peripheral arterial disease.
What are the two types of prevention for cardiovascular disease?
Primary (before any CVS disease) and secondary (after a cardiac event has occurred).
What is involved in primary prevention of atherosclerosis?
Optimizing modifiable risk factors and prescribing medication.
How is medication prescribed in primary prevention?
Based on QRISK3 score (>10% or patient has CKD/Type 1 DM) and prescribing statins.
What are the components of secondary prevention for atherosclerosis? (4as)
Antiplatelet medications, atorvastatin 80mg, atenolol (or alternative beta blocker), ACE inhibitor.
What are the most common side effects of statins? (4)
- Myopathy
- Rhabmyolysis
- type 2 diabetes
- very rare - haemorrhage stroke
What is a key interaction of statins?
Macrolide antibiotics
what is given prophylactically to prevent venous thromboembolism (VTE)
low molecular weight heparin eg. enoxaparin
