clinical aspects of thrombosis

Question 1

thrombosis

Answer 1

inappropriate blood coagulation within a vessel

Question 2

types of thrombosis

Answer 2

arterial circualrion

venous circualrion

Question 3

arterial circulation thrombosis

Answer 3

high pressure system

platelet rich e.g. MI, thrombotic stroke

Question 4

venous system thrombosis

Answer 4

low pressure sysetm
throb are fibrin rich (involve coagulation cascade)
e.g. deep vein thrombosis
pulmonary embolism

Question 5

treatment summary for each type

Answer 5

Arterial thrombosis
- thrombi are platelet rich therefore required antiplatet drugs
Venous thrombosis
- fibrin rich as a result of activation of the coagulation cascade, require anticoagulant drugs

Question 6

how does atherosclerotic plaque develop

Answer 6

• initial fatty steak
• plaque enlargement
• turbulence due to protrusion into lumen
• loss of endothelium and collagen exposure
• platelet activation and adherence on top of the rupture
• fibrin meshwork deposition and red cell entrapment
• more turbulence, more platelet and fibrin deposition
• thrombus of layers of platelets, fibrin and red cells
• get thrombus with layers, blocks the blood vessel
• anything distal does not get a blood supply

Question 7

risk factors for arterial thromosis

Answer 7

Main risk factors
-	family history 
-	diabetes mellitus
-	hypertension
-	hyperlipidaemia
-	smoking
-	atrial fibrillation for stroke
Other risk factors
-	male
-	polycythaemia, gout
-	collagen vascular disease
-	lupus anticoagulant high FVIII, high fibrinogen

Question 8

management of arterial thrombosis

Answer 8

Lifestyle
-	quit smoking
-	exercise
-	diet
-	weight control
Drugs:
Antithrombotic
-	primary prevention in patients with atrial fibrillation

Question 9

treatment options of arterial thrombosis

Answer 9

aspirin

clopidogrel

Question 10

asprin

Answer 10

irreversible inhibitor of COX1 inhibiting production of thromboxane
inhibition lasts lifetime of platelet

Question 11

clopidogrel

Answer 11

irreversible ADP mediated platelet inhibition

Question 12

indictions for use of thrombolysis

Answer 12

MI
stroke within 3 hours
life threatening pumlmonary embolism

Question 13

drugs used for thrombolysis

Answer 13

alteplase

streptokinase

Question 14

invasive treatement of artieral thrombosis

Answer 14

1) percutaneous coronary intervention (caridiac stenting)
- combined with 3-12 months asprin and clopidogrel
2) coronary artery bypass grafting
3) carotid endarterectomy

Question 15

how does atrial fibrillation cause a stroke

Answer 15

1) Blood pools in atria
2) blood clot forms
3) blood clot breaks off
4) blood clot travels to brain and bocks cerebral artery causing a stroke

Question 16

venous thrombosis can lead to

Answer 16

pulmonary embolism -
pulmonary hypotension - chronic PE - death

or
deep vein insufficiency
post thrombotic syndrome
leg ulcers

Question 17

formation of venous thrombosis requres a combination of

Answer 17

hypercoagulability (inherited or aquired)
vascular damage (A)
stasis (A)

Question 18

acquired causes of venous thrombosis

Answer 18

age
previoys VTE
malignancy 
pregnancy 
chemotherapy 
hormone replacement therapy

Question 19

types of heritable thrombophilias and mechanisms

Answer 19

factor V leiden

- protein C resistance

Question 20

what type of disorder is VTE

Answer 20

multifactorial disrder

• interplay of genetic and environmental risk factors
• reaches threshold

Question 21

VTE and dental surgey

Answer 21

all its must be risk assessed on admition to hospital and reassessed within 24 hrs

Question 22

treatment options for acute VTE

Answer 22

1) Anticoagulation
- prevent coagulation cascade
- prevent fibrin formation
2) thrombolysis
- breakdown the clot
3) thrombectomy
4) inferior vena cava filter
- used for those that cannot use anticoagulation

Question 23

treatment for long term VTE

Answer 23

anticoagulation

stockings

Question 24

how long should treatment last for VTE

Answer 24

3 months after first event

Provoked events do not need anticoagulation >3 months
Distal DVT do not need anticoagulation > 3 months

Consider long term anticoagulation after 1st unprovoked thrombosis