Block C - stroke Flashcards
what is thrombosis and what does it lead to ?
This is a pathological condition that results in clot formation in a blood vessel. If the clot (thrombus) is large enough it can restrict blood flow leading to ischaemia and could lead to necrosis in this area.`
commenest cause of death in pregnancy ?
lood clots in veins are the commonest cause of death in pregnant women (linked to being overweight or obese).
stroke ?
A major blood vessel is blocked, for example by a thrombus at a bifurcation of a blood vessel or an emboli more distant that breaks off and travels into more narrow blood vessels such as the brain as shown here and blood carrying oxygen and glucose can not reach the tissue. The brain is particularly vulnerable to emboli as the vessels in the brain are usually narrower.
where do DVT occur ?
Occurs in a vein that is situated deep within the body (e.g. femoral vein in leg). Can result in pulmonary embolism which, if left untreated, can be fatal. This is because the thrombus can break off into emboli and travel throughout the body and lodge in areas that are distant from the original thrombus.
normal blood physiology hinge on ?
Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors.
3 key processes for DVT?
Decreased blood flow (venous stasis)
Increased tendency to clot (hypercoagulability)
Changes to the endothelium (lining) of the blood vessel e.g. physical damage or endothelial activation.
is venis stasis alone enough to cause thrombis
Venous stasis alone appears to be insufficient to cause thrombus formation. The concurrent presence of venous stasis and vascular injury or hypercoagulability greatly increases the risk for clot formation. As blood flow slows, oxygen tension declines with a coincident increase in hematocrit. The hypercoagulable micro-environment that ensues may downregulate certain antithrombotic proteins that are preferentially expressed on venous valves including thrombomodulin and endothelial protein C receptor. In addition to reducing important anticoagulant proteins, hypoxia drives the expression of certain procoagulants. Among these is P-selectin, an adhesion molecule which attracts immunologic cells containing tissue factor to the endothelium.
treatment for DVT ?
DVT is a major preventable cause of global morbidity and mortality. Injectable anticoagulant is essential for example heparin or thrombin inhibitor. The goal is to prevent progression to pulmonary embolism and recurrence of thrombosis. Oral anticoagulant like warfarin (vit K antagonist) or thrombin inhibitor such as dabigatran etexilate or rivaroxaban are given.
It is important to remember that there is a wide variation in response to warfarin and the dose needs to be individualised and effects monitored.
critical role of thrombin in clot formation ?
Thrombin is the link between vascular injury, coagulation and platelet activation. Thrombin converts fibrinogen into fibrin, which is a major component of blood clots.
what happens if thrombin is inhibited ?
If we inhibit thrombin then this will inhibit the ability for the clot to form as fibrin is blocked
heparin ?
Heparin binds to the enzyme inhibitor antithrombin III (ATIII) causing a conformational change that results in its activation. Once activated, ATIII then indirectly inactivates thrombin, factor Xa and other proteases acting as an anticoagulant
role of platelets in clot ?
Platelets play an important central role in the formation for a clot by thrombus initiation, ).
platelet inhibitor ?
hence antiplatelets are used in secondary stroke prevention (e.g., aspirin, clopidogrel
why do ischeamic strokes occur ?
Ischaemic strokes usually occur due to thrombosis (blockage of a small blood vessels) of a major cerebral artery
In ischaemic stroke, a major blood vessel is blocked, for example by a thrombus at a bifurcation of a blood vessel or an emboli more distant that breaks off and travels into more narrow cerebral blood vessels as shown here and blood carrying oxygen and glucose can not reach the tissue. The brain relies heavily on its blood supply for its glucose and tissue that is deprived of oxygen and glucose becomes damaged.
haemorrhagic strokes ?
Haemorrhagic strokes (~15% of strokes) are due to rupture of a cerebral artery, bleed in the brain. In haemorrhagic stroke, there are two type intracerebral and subarachnoid