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402: OHP > Clotting disorders and VTE > Flashcards

Clotting disorders and VTE Flashcards

1
Q

Complications of DVT

A

Pulmonary embolism

Chronic venous insufficiency/ varicose veins

Thrombophlebitis

Post-thrombotic syndrome

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2
Q

Provoked DVT is definied as…

A

DVT with recent (within 3 months) clinical risk factor for VTE

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3
Q

Unprovoked DVT is definied as…

A

DVT with no major clinical risk factors

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4
Q

Clinical risk factors for DVT

A

Previous DVT

Trauma

Hypercoagulable state: thrombophilia, pregnancy, HRT/ COCP, malignancy, antiphospholipid syndrome

Venous stasis: recent surgery, long haul flight (>6 hours), wheelchair bound/ immobilised

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5
Q

Presentation of DVT

A

Unilateral, acute limb pain/ tenderness
- Most common leg

Pain triggered by weight bearing

Red, warm, swollen limb

Venous distention

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6
Q

Features of the 2-level DVT Wells score

A

Previous DVT

Coagulopathy
- Active cancer

Venous stasis
- Paralysis/ paresis/ plaster immobilisation
- Recently bedridden (3 days/ major surgery in last 12 weeks.

Clinical signs
- Whole leg swelling
- Pitting oedema
- Calf diameter >3cm from asymptomatic leg
- Collateral superifical veins

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7
Q

What is the indication for thrombolysis in DVT

A

Symptomatic iliofemoral DVT AND:
- Onset within 14 days
- Good functional status
- 1 year + life expectancy
- Low risk of bleeding

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8
Q

Medical management of unprovoked DVT

A
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9
Q

Investigation in DVT presentation scoring ‘likely’ on 2-level Wells score

A

Proximal leg vein ultrasound scan (Doppler)
- Within 4 hours

If scan not avilable
- D-dimer
- interim anticoagulation

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10
Q

Medications used for proximal DVT/ PE

A

First line
- Rivoraxaban
- Apixaban

2nd line
- LMWH for 5 days
- Followed by dabigatran/ edoxaban
- OR LMWH + warfarn for 5 days.

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11
Q

Patients receiving anti-coagulant treatment should be provided with what?

A

Anticoagulation alert card and booklet.

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12
Q

IVC filters are indicated when in DVT

A

Recurrent PEs

Contraindicated anticoagulation

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13
Q

Post-thrombotic syndrome describes…

A

Chronic venous hypertension after VTE.

Leads to
- Leg pain/ swelling
- Skin changes: hyperpigmentation, dermatitis, liposclerodermatitis, ulcers, gangrene

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14
Q

How long should anticoagulation for VTE be continued in active cancer

A

3 months
- Review then weigh risks/ benefits.

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15
Q

Complications of PE

A

Respiratory failure

Chronic thromboembolic pulmonary hypertension

Death

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16
Q

Clinical signs of PE

A

Sinus tachycardia

Pleural rub on auscultation

Elevated JVP

Gallop rhythm

17
Q

Features of the 2 level PE Wells score

A

3 points
- Classical DVT features

1.5 points
- Tachycardia
- Immobilisation (3+ days)
- Surgery within 4 weeks
- Previous DVT/ PE

1 point
- Haemoptysis
- Active cancer

18
Q

A ‘likely’ PE wells score is…

A

> 3 points

19
Q

What are some ECG features in a PE

A

Sinus tachycardia

S1Q3T3
- Deep S wave in lead 1
- Deep Q wave in lead 3
- Inverted T wave in lead 3

Right axis deviation

RBBB

20
Q

How is haemophilia inherited

A

X-linked recessive

21
Q

haemophilia A is deficiency in _____
haemophilia B is deficiency in _____

A

A- factor 8
b- factor 9

22
Q

What clotting pathway is affected in haemophilia A&B

A

Intrinsic

23
Q

______ activates factor 8

A

Activated protein C

24
Q

What is the clotting profile for haemophilia A

A

Prolonged aPTT

Normal PT, bleeding time, vWF

Low Factor VIII to protein C ratio

25
Q

What is the clotting profile for haemophilia B

A

Prolonged aPTT

Normal PT, bleeding time

vWF may be raised

Low percentage of functioning factor IX

26
Q

Type ____ is the least severe form of von Willebrand disease

A

Type 1
- Partial reduction in vWF

27
Q

vWF is a carrier for factor _____

A

VIII

28
Q

von Willebrand disease is mainly inherited via what mechanism

A

Autosomal dominant

29
Q

Clotting profile of von Willebrand disease

A

Prolonged bleeding time
- normal platlet count

Reduced factor 8

Normal PT (aPTT prolonged in severe disease)

Defective ristocetin platelet aggregation

30
Q

_____ can be giving to raise vWF in active bleeding

A

Desmopressin

31
Q

Idiopathic thrombocytopenic purpura treatment
- Non active bleeding
- Severe thrombocytopenia

A

Non active bleeding/ non severe
- Observation, resolves within 3 months

life-threatening
- Corticosteroids
- IV immunoglobulins
- Platetlet transfusion

32
Q

Findings on blood test for ITP

A

Low platelets- all other cell count is normal

Antiplatelet autoantibodies

33
Q

_____ may trigged ITP

A

Viral infections

34
Q

Examples of factors associated with thrombotic thrombocytopenic purpura

A

Cytotoxic drugs (cyclosporin)

SLE

Pregnancy

OCP

35
Q

TTP presentation

A

Fever

Microvascular thrombosis
- Purpuric rash
- Ecchymosis

Haemolytic anaemia (microangiopathic)

AKI

Altered mental status

36
Q

Antibodies present in anti-phospholipid syndrome

A

Anti-cardiolipin antibodies

Lupus anticoagulant

anti-apolipoprotein antibodies

402: OHP (9 decks)

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