What is thrombosis?
Inappropriate coagulation in vessel (appropriate coagulation when blood escapes vessel)
2 types of thrombosis?
Arterial thrombosis: high pressure, platelet rich –> lead MI, stroke
Venous thrombosis: low pressure, fibrin rich–> lead PE, DVT
Tx of arterial vs venous thrombosis?
Arterial: anti-platelet
Venous: anticoagulant
Formation of atherosclerotic plaque to thrombosis?
- Vessel damage
- Initial fatty streak - lipid accumulation in foamy macrophage in tunica intima
- Plaque enlargement
- Turbulence due to protrusion in lumen
- Loss endothelium and exposure collagen
- Platelet activation and adherence
- Fibrin meshwork entrap RBC
- More turbulence, more deposition
RF arterial thrombosis?
Diabetes, hypertension, hyperlipidemia, smoking, AF
Management arterial thrombosis?
- Lifestyle: smoking cessation, exercise, diet
- Pharmacological: antiplatlets
- Thrombolysis
How does aspirin work?
ANTIPLATELET
Irreversible inhibition cyclo-oxygenase - inhibit production thromboxane (activate platelet)
Life span platelet = 1 week
How does clopidogrel work?
ANTIPLATLET
Irreversible ADP mediated platelet inhibition
Indication for thrombolysis
MI, life threatening PE
2 type of thromoblysis?
- Drugs - streptokinase
- Invasive - percutaneous coronary intervention combined 3-12 month DAPT
- Rehab in all case
What is AF and how does it cause stroke?
Atrial fibrillation - irregular heart rhythm can lead to arterial thrombus and embolism leading to stroke
Blood pool atria –> blood clot form –> blood clot break off –> travel to brain and block cerebral artery
Tx AF
DC cardioversion
Heart rate control
How do venous thrombosis form?
Virchow’s triad
- Hyper-coagulability
- Stasis
- Vessel wall damage
RF venous thrombosis?
Heritable: FAPP - factor V leaden, antithrombin deficiency, protein C/S deficiency, prothrombin mutation
Acquired: age, previous VTE, major surgery or trauma, pregnancy, OCP, obesity
Prevention strategies for venous thrombosis?
- Hydration and mobilisations
- Mechanical prophylaxis: elastic compression, pneumatic compression
- Chemical prophylaxis: low molecular weight heparin, direct oral anticoagulant
Tx venous thromboembolism?
Acute: anticoagulation, thrombolysis, thrombectomy
Long term: anti-coag, stockings
