Disorders of coagulation Flashcards
what are the three elements of virchows triad
- Changes in the intimal surface of the blood vessel
- Changes in the blood constituents
- Changes in the pattern of blood flow
give an example of changes to the intimal surface of vessels
atherosclerosis
what is a condition that promotes a hyperocagulable state
pregnancy
what is the difference in colour and contents between an arterial and venous clot
arterial = white (platelets and fibrin) Venous = red (RBC and fibrin)
what is the outcome of a arterial clot
ischaemia
what is the outcome of a venous clot
backpressure
what principally causes arterial thrombosis
atherosclerosis (changes to epithelial surface)
What principally causes venous thrombosis
stasis and hypercoagulability
give examples of arterial thrombosis
- Coronary thrombosis: MI, unstable angina
- Cerebrovascular thromboembolism: stroke, transient ischaemia
- Peripheral embolism: acute limb ischaemia
ggive examples of venous thrombosis
- Limb deep vein thrombosis
- Pulmonary embolism
- Systemic disease associated with venous thrombosis
- Cancer
- Myeloproliferative neoplasms
- Autoimmune disease
- IBD
- Connective tissue disease
- SLE
- Antiphospholipid syndrome: arterial and venous thrombosis
what are risk factors for arterial thrombosis
- Age
- Smoking
- Sedentary lifestyle
- Hypertension
- Diabetes mellitus
- Obesity
- Hypercholesterolaemia
how would you manage arterial thrombosis
- Primary prevention
- Lifestyle modification
- Treatment of vascular risk factors
- Acute presentation
- Thrombolysis
- Antiplatelet/anticoagulation drugs
- Secondary prevention:
- Aspirin
- Antiplatelet: clopidogrel or ticagrelor for up to 12 months
- Atorvastatin
- ACEi
- Atenolol
- Aldosterone antagonists for those with HF
what are risk factors for venous thrombosis
- Risk factors (those associated with stasis/hypercoagulability):
- Increasing age
- Surgery
- Pregnancy
- Hormonal therapy (COCP/HRT/tissue trauma)
- Immobility
- Obesity
- Systemic disease
- Family history
Name two scoring systems used in the diagnosis of venous thrombosis
Wells and geneva
what investigations are used in the diagnosis of venous thrombosis
- Pretest probability scoring
- Wells score
- Geneva score
- Laboratory testing if pretest probability low
- D-dimer
- Imaging
- Doppler US
- Ventillation perfusion scan (V/Q)
- CT pulmonary angiogram
