Clotting disorders and VTE Flashcards
Complications of DVT
Pulmonary embolism
Chronic venous insufficiency/ varicose veins
Thrombophlebitis
Post-thrombotic syndrome
Provoked DVT is definied as…
DVT with recent (within 3 months) clinical risk factor for VTE
Unprovoked DVT is definied as…
DVT with no major clinical risk factors
Clinical risk factors for DVT
Previous DVT
Trauma
Hypercoagulable state: thrombophilia, pregnancy, HRT/ COCP, malignancy, antiphospholipid syndrome
Venous stasis: recent surgery, long haul flight (>6 hours), wheelchair bound/ immobilised
Presentation of DVT
Unilateral, acute limb pain/ tenderness
- Most common leg
Pain triggered by weight bearing
Red, warm, swollen limb
Venous distention
Features of the 2-level DVT Wells score
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
What is the indication for thrombolysis in DVT
Symptomatic iliofemoral DVT AND:
- Onset within 14 days
- Good functional status
- 1 year + life expectancy
- Low risk of bleeding
Medical management of unprovoked DVT
Investigation in DVT presentation scoring ‘likely’ on 2-level Wells score
Proximal leg vein ultrasound scan (Doppler)
- Within 4 hours
If scan not avilable
- D-dimer
- interim anticoagulation
Medications used for proximal DVT/ PE
First line
- Rivoraxaban
- Apixaban
2nd line
- LMWH for 5 days
- Followed by dabigatran/ edoxaban
- OR LMWH + warfarn for 5 days.
Patients receiving anti-coagulant treatment should be provided with what?
Anticoagulation alert card and booklet.
IVC filters are indicated when in DVT
Recurrent PEs
Contraindicated anticoagulation
Post-thrombotic syndrome describes…
Chronic venous hypertension after VTE.
Leads to
- Leg pain/ swelling
- Skin changes: hyperpigmentation, dermatitis, liposclerodermatitis, ulcers, gangrene
How long should anticoagulation for VTE be continued in active cancer
3 months
- Review then weigh risks/ benefits.
Complications of PE
Respiratory failure
Chronic thromboembolic pulmonary hypertension
Death
Clinical signs of PE
Sinus tachycardia
Pleural rub on auscultation
Elevated JVP
Gallop rhythm
Features of the 2 level PE Wells score
3 points
- Classical DVT features
1.5 points
- Tachycardia
- Immobilisation (3+ days)
- Surgery within 4 weeks
- Previous DVT/ PE
1 point
- Haemoptysis
- Active cancer
A ‘likely’ PE wells score is…
> 3 points
What are some ECG features in a PE
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
How is haemophilia inherited
X-linked recessive
haemophilia A is deficiency in _____
haemophilia B is deficiency in _____
A- factor 8
b- factor 9
What clotting pathway is affected in haemophilia A&B
Intrinsic
______ activates factor 8
Activated protein C
What is the clotting profile for haemophilia A
Prolonged aPTT
Normal PT, bleeding time, vWF
Low Factor VIII to protein C ratio
What is the clotting profile for haemophilia B
Prolonged aPTT
Normal PT, bleeding time
vWF may be raised
Low percentage of functioning factor IX
Type ____ is the least severe form of von Willebrand disease
Type 1
- Partial reduction in vWF
vWF is a carrier for factor _____
VIII
von Willebrand disease is mainly inherited via what mechanism
Autosomal dominant
Clotting profile of von Willebrand disease
Prolonged bleeding time
- normal platlet count
Reduced factor 8
Normal PT (aPTT prolonged in severe disease)
Defective ristocetin platelet aggregation
_____ can be giving to raise vWF in active bleeding
Desmopressin
Idiopathic thrombocytopenic purpura treatment
- Non active bleeding
- Severe thrombocytopenia
Non active bleeding/ non severe
- Observation, resolves within 3 months
life-threatening
- Corticosteroids
- IV immunoglobulins
- Platetlet transfusion
Findings on blood test for ITP
Low platelets- all other cell count is normal
Antiplatelet autoantibodies
_____ may trigged ITP
Viral infections
Examples of factors associated with thrombotic thrombocytopenic purpura
Cytotoxic drugs (cyclosporin)
SLE
Pregnancy
OCP
TTP presentation
Fever
Microvascular thrombosis
- Purpuric rash
- Ecchymosis
Haemolytic anaemia (microangiopathic)
AKI
Altered mental status
Antibodies present in anti-phospholipid syndrome
Anti-cardiolipin antibodies
Lupus anticoagulant
anti-apolipoprotein antibodies
