CP44 - thrombosis and risk factors for thrombosis Flashcards
what is the virchow’s triad
blood flow, vessel endothelium, blood composition
what is the main problem in arterial thrombosis?
vascular disease
what are the main pathogenesis for venous thrombosis?
venous stasis (flow), hyper coagulable states
how can a DVT cause death
pulmonary embolism
what is the incidence for venous thromboembolism ?
1 per 1000 pa
what is thrombotic syndrome
due to the damages to the veins of the legs due to VTE
how many deaths are caused by hospital acquired VTE
60 K
what is the definition of hospital acquired VTE?
any VTE happen within 90 days of discharge and during admission
how is VTE prevent
prophylaxis
what are some risk factors for VTE?
active cancer, age, surgery, major traum, oestrogen-containning contraceptive
what is the pharmacological prophylaxis for preventing VTE?
low dose low molecular weight heparin
how does heparin work?
binds to anti-thrombin so it can not be activated
what are some exclusion test of VTE
Wells score, D-dimer test
what is D-dimer
breakdown product of fibrin clot by plasmin - ie D-dimer will tell specific about plasmin breaking clot
why is USS used after the D-dimer test
D- dimer test - high false positive rate - so need USS to test for actual clot
what are the treatments for VTE?
low molecular weight heparin and overlap with warfin
what are some examples of anticoagulants drugs
rivaroxaban
apixaban
dabigatran
what does recurrent VTE require in terms of treatment
long term therapeutic anticoagulation
what is Thrombophilia
Thrombophilias are familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis.
what are the other definition for thrombophilia
Patients who develop VTE:
Spontaneously
Of disproportionate severity
Recurrently
At an early age
what are some examples for heritable thrombophilias
Antithrombin deficiciency Protein C deficiency Protein S deficiency Activated Protein C resistance/FV Leiden Dysfibrinogenaemia Prothrombin 20210A
what are some examples for acquired thrombophilias
antibodies - antiphospholipid syndrome
what are some clinical features of therombophilia
DVT
PE
superfifical thrombophlebitis - acquired
recurrent miscarriage - acquired
what does antithrombin inhibit?
factor Xa & thrombin
what des activated protein C & S complex degrade?
factor Va & VIIIa
How does Factor V Leiden work?
APC resistance - single point mutation with another protein replaced and so resistance to cleavage by APC
what is the most common thrombophilia
Factor V leiden
what is antiphospholipid syndrome
antiphospholipid antibodies present
how is antiphospholipid syndrome tested?
tested separately at least 2 occasions 8 weeks apart
