CP44 - thrombosis and risk factors for thrombosis

Question 1

what is the virchow’s triad

Answer 1

blood flow, vessel endothelium, blood composition

Question 2

what is the main problem in arterial thrombosis?

Answer 2

vascular disease

Question 3

what are the main pathogenesis for venous thrombosis?

Answer 3

venous stasis (flow), hyper coagulable states

Question 4

how can a DVT cause death

Answer 4

pulmonary embolism

Question 5

what is the incidence for venous thromboembolism ?

Answer 5

1 per 1000 pa

Question 6

what is thrombotic syndrome

Answer 6

due to the damages to the veins of the legs due to VTE

Question 7

how many deaths are caused by hospital acquired VTE

Answer 7

60 K

Question 8

what is the definition of hospital acquired VTE?

Answer 8

any VTE happen within 90 days of discharge and during admission

Question 9

how is VTE prevent

Answer 9

prophylaxis

Question 10

what are some risk factors for VTE?

Answer 10

active cancer, age, surgery, major traum, oestrogen-containning contraceptive

Question 11

what is the pharmacological prophylaxis for preventing VTE?

Answer 11

low dose low molecular weight heparin

Question 12

how does heparin work?

Answer 12

binds to anti-thrombin so it can not be activated

Question 13

what are some exclusion test of VTE

Answer 13

Wells score, D-dimer test

Question 14

what is D-dimer

Answer 14

breakdown product of fibrin clot by plasmin - ie D-dimer will tell specific about plasmin breaking clot

Question 15

why is USS used after the D-dimer test

Answer 15

D- dimer test - high false positive rate - so need USS to test for actual clot

Question 16

what are the treatments for VTE?

Answer 16

low molecular weight heparin and overlap with warfin

Question 17

what are some examples of anticoagulants drugs

Answer 17

rivaroxaban
apixaban
dabigatran

Question 18

what does recurrent VTE require in terms of treatment

Answer 18

long term therapeutic anticoagulation

Question 19

what is Thrombophilia

Answer 19

Thrombophilias are familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis.

Question 20

what are the other definition for thrombophilia

Answer 20

Patients who develop VTE:

Spontaneously
Of disproportionate severity
Recurrently
At an early age

Question 21

what are some examples for heritable thrombophilias

Answer 21

Antithrombin deficiciency
Protein C deficiency
Protein S deficiency
Activated Protein C resistance/FV Leiden
Dysfibrinogenaemia
Prothrombin 20210A

Question 22

what are some examples for acquired thrombophilias

Answer 22

antibodies - antiphospholipid syndrome

Question 23

what are some clinical features of therombophilia

Answer 23

DVT
PE
superfifical thrombophlebitis - acquired

recurrent miscarriage - acquired

Question 24

what does antithrombin inhibit?

Answer 24

factor Xa & thrombin

Question 25

what des activated protein C & S complex degrade?

Answer 25

factor Va & VIIIa

Question 26

How does Factor V Leiden work?

Answer 26

APC resistance - single point mutation with another protein replaced and so resistance to cleavage by APC

Question 27

what is the most common thrombophilia

Answer 27

Factor V leiden

Question 28

what is antiphospholipid syndrome

Answer 28

antiphospholipid antibodies present

Question 29

how is antiphospholipid syndrome tested?

Answer 29

tested separately at least 2 occasions 8 weeks apart