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Haematological Disease > Clinical Aspects Of Thrombosis > Flashcards

Clinical Aspects Of Thrombosis Flashcards

1
Q

What is thrombosis?

A

Inappropriate blood coagulation within a vessel is called thrombosis

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2
Q

What are the two types of thrombosis?

A
  1. ) In arterial circulation:
    - High pressure system
    - Platelet rich
  2. ) In the venous circulation:
    - Low pressure system
    - Fibrin rich
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3
Q

What are the types of thrombosis in Arterial and Venous thrombosis (2 each)

A

ARTERIAL:
1.) Myocardial Infarction

2.) Thrombotic Stroke

VENOUS:
1.) Leg deep vein thrombosis (MI)

2.) Pulmonary Embolism (PE)

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4
Q

What type of drugs do we treat thrombosis with?

A
  • Arterial thrombosis - ANTIPLATELET drugs

* Venous thrombosis - ANTICOAGULANT drugs

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5
Q

Describe the formation of arterial thrombosis

A

• Atherosclerotic plaque

  • Initial fatty streak
  • Plaque enlargement
  • Turbulence due to protrusion in lumen
  • Loss of endothelium and collagen exposure
  • Platelet activation and adherence
  • Fibrin meshwork deposition and red cell entrapment
  • More turbulence, more platelet and fibrin deposition
  • Thrombus of layers and platelets, fibrin and red cells
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6
Q

What are the risk factors for Arterial Thrombosis?

A 
MAIN:
• Family history
• Diabetes Mellitus
• Hypertension
• Hyperlipidaemia
• Smoking
• Atrial fibrillation for stroke

OTHER:
• Male
• Polycythaemia, gout
• High FVIII

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7
Q

How do we manage Arterial thrombosis

A
  • Stop smoking
  • Exercise
  • Diet
  • Weight Control

• Antithrombotics: primary prevention in patients with atrial fibrillation

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8
Q

What drugs are used to treat arterial thrombosis

A

Antiplatelets

  • Aspirin
  • Clopidogrel
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9
Q

How does Aspirin work?

A
  • Inhibits COX1 which inhibits the production of thromboxane
  • Inhibition lasts for lifetime of platelet (1 week)
  • Risk reduce of non fatal vascular event by 30% and fatal vascular event 15%
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10
Q

How does Clopidogrel work?

A
  • Irreversible ADP mediated platelet inhibition
  • Inhibition lasts for lifespan of platelet (1 week)
  • Decreases MI risk 18%
  • Risk of coronary stent thrombosis/recurrent stroke by 30%
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11
Q

Thrombolysis is another tmt option for AT. What are the indications for this?

A
  • MI
  • Stroke within 3 hours
  • Life-threatening PE
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12
Q

Drugs used in thrombolysis

A
  • ALTEPLASE
  • STREPTOKINASE
  • SIDE EFFECT: BLEEDING
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13
Q

What are the invasive procedures for AT

A

• Percutaneous coronary intervention (cardiac stenting)
- Combined with 3-12 month aspirin and clopidogrel

• REHABILITATION IN ALL CASES:
- Stroke: swallowing, malnutrition, mobilisation

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14
Q

Describe secondary preventative measures for Arterial Thrombosis

A 
- LIFESTYLE:
• Exercise
• Stop smoking
• Diet
• Weight control
• Safe alcohol use
  • BLOOD PRESSURE CONTROL
  • CHOLESTROL LOWERING
  • DIABETIC CONTROL
  • ANTITHROMBOTIC THERAPY IN STROKE ASSOCIATED WITH ATRIAL FIBRILATION
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15
Q

What is atrial fibrillation?

A
  • Irregularly irregular heart rhythm
  • 4% > 60yrs 8% > 80yrs
  • Left atrial thrombus
  • Embolisation leads to stroke
  • Impaired cardiac output

• Treatment:
- DC cardioversion

  • Heart rate control: Beta blockers, Ca channel blocker, Digoxin, AV junction ablation
  • Anticoagulation
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16
Q

How does AF cause stroke?

A
  1. ) Blood pools in atria
  2. ) Blood clot forms
  3. ) Blood clot breaks off
  4. ) Blood clot travels to brain and blocks a cerebral artery causing a stroke
17
Q

What is venous thrombosis?

A

Most VT starts as Deep Vein Thrombosis (DVT) usually in the leg

18
Q

What are the two outcomes for DVT

A
  1. ) The clot from the leg breaks up and goes to the lungs, leading to a pulmonary embolism.
    - This can lead to pulmonary hypertension followed by:
    - chronic PE can lead to death.
  2. ) The clot blocks the flow up the leg leading to deep vein insufficiency followed by:
    - Post-thrombotic syndrome
    - Leg ulcers
19
Q

What are the three main risk factors for venous thrombosis1

A
  1. ) Stasis (poor blood flow)
  2. ) Vascular damage
  3. ) Hypercoagulability (contents of blood abnomal)
20
Q

Name some heritable risk factors for Venous Thrombosis

A
  • Antithrombin deficiency
  • Protein C & S deficiency
  • Prothrombin mutation 20210 A
21
Q

Name some acquired risk factors for venous thrombosis

A
  • Age
  • Previous vte
  • Malignancy
  • Pregnancy
  • Chemotherapy
  • Obesity
  • HRT
22
Q

Nam some mixed risk factors for venous thrombosis

A
  • Raised FVIII
  • Raised FIX
  • Raised XI
  • Raised Fibrinogen
23
Q

Describe preventative strategies for venous thrombosis

A
  • Adequate hydration
  • Early mobilisation

• Mechanical prophylaxis

  • All surgical pts at risk of VTE
  • Intermittent pneumatic compression

• Chemical prophylaxis prevents 50-70% of VTE:

  • Low molecular weight heparin
  • Direct oral anticoagulants
24
Q

What is the risk assessment for Venous thrombosis

A
  • NICE guidelines for adults
  • Do not routinely offer pharmacological or mechanical VTE prophylaxis to patients
  • All other patient must be risk assessed on admission and reassessed within 24 hours
25
Q

What are the acute tmt options for VTE

A
  • Anticoagulation
  • Thrombolysis
  • Thrombectomy
  • Inferior vena cava (IVC) filter
26
Q

What are the long-term tmt options for VTE

A
  • Anticoagulation

* Stockings

27
Q

What is the duration of the treatment of VTE

A
  • 3 months after a 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
28
Q

Venous thrombosis - conclusion

A
  • Multifactorial disease
  • Associated with significant mortality/morbidity
  • Prevention essential, especially in hospital setting
  • Treatment mainly with anticoagulants
  • Optimum duration debated
  • Associated with increased risk of bleeding

Haematological Disease (4 decks)

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