Embolism Flashcards
consquences of embolism
Death
Recurrence of embolism
Poooling of blood in legs causing ulcer, pain etc
What factors in the blood can increase the chances of thromboembolism?
Viscosity
- haemtocrit
- protein count
Platelet count
Coagulation system
How do you describe the increased tendency to have a thrombosis?
Thrombophilia
- they might lack antithrombin
or they might have more procoagulative factors
What is protein C?
Protein C is an anticoagulative protein
Which factors can especially promote coagulability if elevated?
Elevated factor 8
Elevated factor 11
Having protein S, protein C, factor 5 leiden deficiency etc increases the chance of embolism, but the curve is so steep there must be other precipitative factors. Name some of these
Surgery
Pill
Pregnancy
The vessel wall is normally _________. Explain how.
Heparins Protein C receptor Thrombomodulin Nitric oxide TF pathway inhibitor (TFPI)
The vessel wall is normally _________. Explain how.
Anticoagulant
HeparAns Protein C receptor Thrombomodulin Nitric oxide TF pathway inhibitor (TFPI)
List some things causing vessel wall injury
Infection
Malignancy
Surgery
Inflammation and injury make you prone to having blood clots.
What is NETosis?
Neutrophils undergo NETosis - a spillage of their DNA
This is prothrombotic
Anticoagulant drugs
Immediate therapy - herapin e.g. apixaban or rivaroxaban
Direct acting anti-Xa or anti 2a
Delayed - vit K antagonists e.g. warfarin
????????
Polycythemia
How does heparin work?
Heparin activates antithrombin
Anticoagulant drug CLASSIFICATION
Immediate therapy - herapin e.g. apixaban or rivaroxaban
Direct acting anti-Xa or anti 2a
Delayed - vit K antagonists e.g. warfarin
What is the difference between heparin and warfarin?
Heparin - SUDDEN
Warfarin - only works after a few days as it is indirect
What is a key side effect of heparin?
Can cause osteoporosis
Renal
treatment?
IV unfractionated herparin
LMWH SC
Pentasaccharide SC - five sugar sequence that worked but it’s too expersneive
Why don’t we just give anticoagulants to everyone?
Because it also increases the risk of bleeding.
The higher the INR, the worse the _____?
risk of bleeding
Anti coag therapy
Prevent
Treat
Prevent further risk
Who is at increased risk of thrombosis?
Inpatients - immobility, inflammation, age Pt with cancer Surgical patietns Previous VTE, FH, genes OBese Elderly
What do we use to PREVENT thrombosis?
Thromboprophylaxis
LMWH at low doses e.g. Enoxaparin 40mg od
Tinxaparin 4500i
TED stockings
maybe DOACs and aspirin in orthopedic patietns
All patients who come in must be assessed for thromboprophylactic anda whether it is safe to give it to them. What do you look for?
Patient factors
Procedural factors (see lecture slide)
What do we use to TREAT thormbosis?
Therapeutic doses of LMWH or DOAC
