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Haematology > Balance of Haemostasis - Thrombosis > Flashcards

Balance of Haemostasis - Thrombosis Flashcards

1
Q

Damage to a vessel will cause it to…

A

Vasoconstrict

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2
Q

Damage to a vessel will cause platelets to

A

adhere and aggregate

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3
Q

What occurs during coagulation?

A

Insoluble fibrin formation

Fibrin cross-linking

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4
Q

What is fibrin converted to in process of fibrinolysis?

A

Fibrinogen and Fibrin Degradation Products (FDP)

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5
Q

What catalyses the breakdown of fibrin?

A

Plasmin

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6
Q

Define the difference between a thrombus and embolism

A

Thrombus- clot in wrong place

Embolism- movement of clot from primary site

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7
Q

When deep vein thrombosis (DVT) occurs, to where does the clot embolise?

A

Pulmonary vasculature

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8
Q

Name the three factors in Virchow’s Triad that contribute to Thrombosis

A

Vessel damage
Stasis
Hypercoagulability

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9
Q

Do all three factors need to coincide in virchows triad for thrombosis to occur?

A

No, imbalance in 1 can be enough to drive thrombosis

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10
Q

What will contribute to Stasis in the blood?

A

Immobility

Travel - specific example of immobitility - particularly long haul

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11
Q

What process can cause vessel damage?

A

Atherosclerosis

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12
Q

What can lead to hypercoagulability and a prothrombotic state?

A

Pregnancy
Hormones
Trauma

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13
Q

What are the constituents of a ‘white clot’

A

Platelets and fibrin

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14
Q

What type of thrombus is a ‘white clot’ ?

A

Arterial thrombus

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15
Q

An arterial thrombus can have what 2 consequences

A

Ischaemia

Infarction (Necrosis)

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16
Q

How does an arterial thrombus occur secondary to atherosclerosis?

A

Plaque that grows on vessel wall can rupture

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17
Q

Name three clinical outcomes of an arterial thrombus

A

Coronary thrombus
Cerebrovascular thromboembolism
Peripheral embolism

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18
Q

Which 2 events/conditons can occur in a patient due to coronary thrombus?

A

Myocardial infarction

Unstable angina

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19
Q

How is unstable angina treated?

A

Stents

Dual antiplatelet therapy

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20
Q

Which 2 events/conditions can occur in a patient due to a cerebrovascular thromboembolism?

A

Stroke

Transient Ischaemia

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21
Q

Name a treatment for stroke

A

Clopidogrel

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22
Q

Where in the body will a peripheral embolism cause ischaemia?

A

The limbs

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23
Q

Name 7 risk factors for arterial thrombosis

A 
Age
Smoking
Hypertension
Obesity
Hypercholesterolaemia
Diabetes
Sedentary lifestyle
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24
Q

What are the three steps of management in arterial thrombosis?

A

Acute management
Primary prevention
Secondary Prevention

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25
Describe primary prevention measures for arterial thrombosis
Lifestyle modification | Treat vascular risk factors
26
Describe acute management of arterial thrombosis
Thrombolysis Antiplatelets or Anticoagulants (combination of aspirin and rivoroxaban lead to better outcomes?)
27
What are the constituents of a red clot?
Red blood cells and fibrin
28
What type of thrombus is a red clot?
Venous thrombus
29
Venous thrombi occur due to which 2 processes included in virchow's triad?
Stasis and hypercoagulability
30
A venous thrombus will cause back pressure to occur in the blood flow. This will have which 2 consequences
Valvular insufficiency | Post thrombotic syndrome
31
Name 5 examples of venous thromboembolism
``` Limb - deep vein thrombosis Pulmonary embolism Visceral venous thromboembolism Intracranial venous thrombosis Superficial thrombophlebitis ```
32
What insufficiency causes deep vein thrombosis?
Chronic venous insufficiency
33
Presentation of DVT is likely how long after it occurs?
2 years
34
What are 4 presenting symptoms of DVT?
Hyperpigmentation Lower limb swelling Redness Venous ulceration
35
Visceral venous thromboembolism in which vein will lead to obstructive jaundice?
Disease of biliary tree leads to portal vein thrombosis --> obstructive jaundice
36
3 symptoms of a patient with intracranial venous thrombosis
Extremely unwell Seizures Bleeding
37
What is first line investigation of IC venous thrombosis?
CT - show clot and haemorrhage
38
What immediate line of treatment can improve the outcome in intracranial haemorrhage that would otherwise be avoided in conditions where the patient is bleeding?
Anticoagulants
39
Why is superficial thrombophlebitis managed differently to DVT?
Risk of extending into deeper veins
40
Name 9 risk factors for venous thrombosis
``` Age Immobility Pregnancy Trauma Obesity Surgery Systemic disease Family history Hormonal - COCP, HRT ```
41
Which hormonal treatments increase the risk of venous thrombosis?
COCP | Oral HRT
42
Which systemic diseases are associated with venous thrombosis?
Cancer Myeloproliferative Neoplasm Autoimmune Any inflammatory conditions
43
Name a few autoimmune conditions associated with venous thrombosis
IBD Connective tissue disease - SLE Polymyalgia Antiphospholipid syndrome
44
Which treatment could be beneficial in patients with chronic inflammatory conditions long-term?
Anticoagulants
45
What 3 investigations are used for diagnosis of venous thrombosis?
Pretest Probability scoring D-dimer Imaging
46
What test is required if prescore is low?
D-dimer
47
How is a patient managed if D-dimer lab result is negative?
Discharged, no admission
48
What investigation is required if patient prescore is high in diagnosis of VT?
Imaging
49
What imaging techniques can be used to diagnose VT?
Doppler US - compression ultrasonography CT Venogram
50
What are the findings in compression ultrasonography if DVT has occurred?
Vein enlarged Non-compressible Echogenic material might be seen
51
Which imaging techniques can be used to diagnose Pulmonary Embolism?
V/Q perfusion scan | CTPA
52
What are the 3 aims of management in thrombosis?
Prevent clot extension Prevent clot embolisation Prevent recurrence of clots in long-term treatment
53
Action of Subcutaneous LMWH?
Acts before fibrin is formed | Prevents clot getting bigger
54
What is the minimum time frame for anticoaguant treatment?
3 months - reviewed for long term use
55
Which 2 factors are considered when reviewing anticoagulant treatment for long-term use?
Is there an ongoing risk factor for thrombosis that has been present for longer than 3 months? Has the patient experienced an unprovoked PE/DVT?
56
Name the 2 classes of drugs/treatments used in thrombosis
Anticoagulants | Thrombolysis
57
Name 3 types of anticoagulants
LMWH Coumarins (Warfarin) DOACs
58
2 groups of patients where LMWH is recommended for anticoagulant treatment
Pregnant women | Cancer patients
59
Disadvantage of warfarin use - patient group warfarin should not be used in
Teratogenic | Pregnant women/ women of child-bearing age
60
Thrombolysis is only recommended in which patient cases of thrombosis
Massive Pulmonary Embolism No evidence beneficial in submassive cases or massive DVTs
61
Which condition gives an inheritable predisposition to venous thrombosis?
Heritable Thrombophilia
62
What is the most common mutation in patients with thrombophilia?
Factor V leiden
63
Factor V leiden mutations promote resistance to which protein?
Protein C
64
Function of Protein C and Protein S
Inhibit clotting factors Va and VIIIa
65
Function of antithrombin
Combines with heparins to inhibit thrombin
66
Is family screening recommended in patients with thrombophilia?
No | Only in high risk circumstances eg antithrombin deficiency
67
When do patients typically present with thrombophilia?
Young | With significant thrombosis
68
Microvascular thrombosis occurs due to which coagulopathy?
Disseminated Intravascular Coagulation | DIC
69
What occurs in DIC?
Drive to thrombus which reduces clotting factors | Will eventually leave prone to increased risk of bleeding
70
Most common case of microvascular thrombosis seen in ICU
Platelets and fibrin clots leading to digital ischaemia
71
Diffuse systemic coagulation activation which can lead to DIC occurs in which 3 conditions
Septicaemia Malignancy Eclampsia
72
Tissue ischaemia leads to
Gangrene | Organ failure
73
What causes bleeding/prolonged clotting time seen in DIC?
Consumption of platelets and clotting factors due to coagulation activation- drive to thrombus formation
74
Management of DIC
Low dose anticoagulants
75
What is the purpose of low dose anticoagulant use in management of DIC?
Reduce the drive to thrombus
76
Why wouldn't clotting factors be used in treatment of DIC?
This would maintain drive created to thrombus

Haematology (7 decks)

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