CPC (Thrombosis, Embolism, Ischaemia and Infarction)

Question 1

Which clotting factors does Warfarin prevent you making?

Answer 1

• 2, 7, 9 and 10

- Takes 5-6 days to start working

Question 2

What are the venous consequences?

Answer 2

• Painful swelling
• Pulmonary embolism
• Recurrent VTE
• Venous insufficiency
• Post thrombotic syndrome

Question 3

What are the arterial consequences?

Answer 3

• Death
• Arrhythmia
• Paricarditis
• Myocardial rupture
• Mitral valve prolapse
• LV aneurysm +/- thrombus
• HF
• Stroke

Question 4

How is DVT treated?

Answer 4

• Anticoagulation for 3-6 months (LMWH, warfarin, DOACs)
• Removal of risk factors
• Pain relief
• Compression stockings

Question 5

Describe the pathophysiology of atherosclerosis

Answer 5

• Foam cells and fatty streaks in sub-endothelial layers
• Thickening of vessel wall and so narrowing of lumen
• Lipid rich material accumulates narrowing lumen further
• Rupture releases pro-thrombotic material so blood passing forms clot

Question 6

How is atherosclerosis treated?

Answer 6

• Prevention of thrombus extension (aspirin, clopidogrel, heparin)
• Removal of thrombus (thrombolysis, PCI)
• Widen the stenotic plaque
• Prevent further thrombus (anti-platlet agent, statin)

Question 7

How is stroke investigated?

Answer 7

• CT of brain

- Spontaneous ECHO contrast in LA to look for source of emboli

Question 8

How are stroke and AF treated?

Answer 8

• Removal of thrombus on rare occasions (thrombolysis, end-arterectomy)
• Correct source of thrombus (anticoagulatin, cardioversion, valve replacement)
• Address other CV risk factors (HTN, hyperlipidaemia)