Clotting Disorders VTE Flashcards

1
Q

What is hemostasis

A

Process to stop bleeding at the site of vascualr injery through complex interactions between vascular endothelium, platelets, procoagulant proteins, anticoagulant proteins and fibrinolytic proteins

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2
Q

What are the three key mechanisms that facilitate hemostasis

A

Vascular constriction, primary platelet plug formation (primary hemostasis), clot propagation through fibrin formation (secondary hemostasis)

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3
Q

What is the basic four step mechanism for platelet aggregation when injury occurs

A

Platelets first adhere to macro molecules in the sub-endothelial regions of the injured blood vessel, platelets activate, adherent platelents release substances that activate nearby platelets and recruit them, activated platelets then aggregate to form the primary hemostatic plug

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4
Q

What protein initiates the coagulation system when exposed due to vessel wall injury

A

Tissue factor

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5
Q

Which thrombin factor is usually seen in this coagulation, what does it do

A

Thrombin (factor IIa), thrombin converts fibrinogen to fibrin reinforcing the platelet aggregation and anchors it to the vessel wall

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6
Q

T/F:The extrinsic and intrinsic pathway both convert into the common pathway for coagulation leading to more thrombin

A

True

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7
Q

What are the natural inhibitors of the coagulation cascade

A

Antithrombin III, Protein C, Protein S

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8
Q

What is the most common defect in the natural coagulant system, what occurs

A

Factor V leiden, mutation in factor V that results in resitance to inactivation by protein C and protein S

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9
Q

What is thrombosis

A

Formation of an inappropriate fibrin-platelet aggregate

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10
Q

Where are sites thrombosis can take place

A

Endothelium of blood or lymphatic vessels (mural thrombus) , within the heart (cardiac thrombus), free in blood or lymphatic vessels (thromboembolus)

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11
Q

What is venous thromboembolism, what are two types

A

Clot formation within the venous circulation, DVT and pulmonary embolism

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12
Q

Where do most DVTs take place

A

The proximal veins (Deep femoral vein and superficial femoral vein)

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13
Q

What is the order of pulmonary embolism types from most dangerous to least dangerous

A

Saddle embolism, lobar embolism, segmental, subsegmental

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14
Q

What guide is used to assess risk for ischemic stroke, what are its parameters

A

CHADS2/ Congestive heart Failure, Hypertension, Age greater than 75, Diabetes, Stroke or Trans ischemic attack

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15
Q

T/F: On the CHADS2 score each category is worth one point

A

False: On the CHADS2 score each category is worth one point except Stroke or TIA, which is worth 2 points

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16
Q

What are the three big risk factors for VTE, what are the collectively called

A

Blood Stasis, Hypercoagulable State, Vascular Injury/ Virchow’s triad

17
Q

What are the other risk factors for VTE

A

Age greater than 40 years, Surgery, Major trauma or lower-extremity injury, Cancer, Pregnancy

18
Q

What medication class can increase risk of blood clots

A

Estrtogens

19
Q

What are situations that could lead to blood stasis

A

Damage to venous valves, periods of proplong immobility, abnormalities of blood flow

20
Q

What disease can cause a hypercoaguable state, other factors

A

Cancer Malignancy, female gender, being black, older age (greater than 40), pregnancy

21
Q

T/F: Smoking increase risk of VTE

A

True

22
Q

What are examples of or may cause vascular injury

A

Trauma, Surgery, Heart valve replacement, Artherosclerosis or Artheromatous plaque, indwelling vascular catheters

23
Q

What orthopedic surgery has the highest risk for VTE

A

Total hip arthroplasty and Hip fracture surgery

24
Q

In hospitalized medical patients what gives the most points on Padua Prediction Risk Assesment Model

A

Active Cancer, Previous VTE, Reduced moblility, Already known thrombophilic condition`

25
Q

What are common signs and symptoms of DVT

A

Swelling, redness, tenderness, edema, palpable cord, post-thrombotic syndrome

26
Q

What are common signs and symptoms of pulmonary embolism

A

Chest pain, cough with blood, tachycardia, palpations, low grade fever, patient passes out

27
Q

What is used to diagnosis if patient as VTE, why is it not always reliable

A

D-Dimer/ elevations can occur due to recent surgeries, increasing age, pregnancy and cancer

28
Q

What risk assesment scale is used to see if a DVT is present

A

Wells pretest/ Tenderness along entire deep vein system, Swelling of the entire leg, greater than 3 cm in calf circumference, pitting edema, collateral superficial veins, active cancer, prolonged immobility or paralysis, recent surgery

29
Q

What does the Wells score need to be in order for DVT to be likely

A

Greater or equal to 2

30
Q

What is the first choice for diagnostic imaging for PE

A

CT pulmonary angiography

31
Q

When using the Wells score for pulmonary embolism put the criteria in order from the highest scores to lowest scores

A

Signs or DVT, Alternative diagnosis to PE less likely ( 3 points)/ History of PE or DVT, heart rate greater than 100 beats/min, recent surgery or immobility (1.5 points)/ Active malignancy and hemoptysis (1 point)

32
Q

What must the Wells score for PE be for it to be most likely present

A

Greater than 4

33
Q

T/F: If the D- dimer is negative PE and DVT is ruled out

A

True

34
Q

What is post-thrombotic syndrome

A

Chronic venous insuffciency as a consequence of valvular incompetence and venous hypertension due to thrombotic obstruction, usually occurs following DVT

35
Q

T/F: Initial VTE treatment should include a rapid-acting anticoagulant

A

True

36
Q

What is the usual dose to start a patient on for warfarin

A

5 mg

37
Q

What is used to monitor heparin, when is it checked

A

aPTT, every 6 hours

38
Q

What syntheizes the major clotting factors, what are three types of factors,

A

Liver/ contact activation factor, vitamin K factor, thrombin-sensitive factor