Hemodynamics Part II: thrombosis

Question 1

components of virchow’s triangle

Answer 1

hypercoagulable state
circulatory stasis
endothelial injury

all lead to thrombosis

Question 2

dominant influence on thrombosis

Answer 2

enothelial injury

especially important in thrombus formation in heart and arterial circulation

Question 3

factor V leiden mutation

Answer 3

hypercoagulable state

glutamine substitutes for arginine at position 506 of factor V protein

causes resistance to degradation by activated prtn C —> increased probability of thrombosis

Question 4

prolonged bedrest or immobilization —.

Answer 4

high risk for thrombosis

Question 5

antiphospholipid antibody syndrome

Answer 5

serum antibodies directed against anionic phospholipids

causes hypercoagulable state in vivo (inhibit clotting in vitro)

associated with lupus

observe: recurrent venous or arterial thrombi, repeated miscarriages, cardiac valve vegetations, thrombocytopenia

Question 6

disruption of normal laminar flow

Answer 6

turbulence

forms countercurrents causing local pockets of stasis which prevents dilution of clotting factors, prevents inflow of clotting inhibitors and promotes endothelial cell activation

Question 7

growth promoting agents

Answer 7

angiotensin II
endothelin 1
platelet derived growth factor

Question 8

growth inhibiting agents

Answer 8

NO

TGF-beta

Question 9

prothrombotic agents

Answer 9

MCP-1

VCAM-1`

Question 10

antithrombotic agents

Answer 10

NO
prostacyclin
tissue plasminogen activator
thrombomodulin

Question 11

sites of endothelial injury –>

Answer 11

arterial thrombi

Question 12

consequence of stasis —>

Answer 12

venous thrombi

Question 13

thrombi have a point of _________ attachment to the vessel

Answer 13

firm

Question 14

risk factors for arterial thrombosis

Answer 14

MI
rheumatic heart disease
atrial fibrillation
atherosclerosis

Question 15

incidence of arterial thrombi

Answer 15

coronary artery > cerebral artery > femoral artery

Question 16

what is an areterial thrombi composed of?

Answer 16

platelets
fibrin
erythrocyte
leukocyte

Question 17

when is stenting or surgery recommended for aneurysms?

Answer 17

greater than 5cm in diametere

Question 18

what are lines of zahn in a thrombus

Answer 18

alternate layering of platelets, fibrin and erythrocytes

Question 19

aka phlebothrombosis

Answer 19

venous thrombosis

Question 20

where do venous thrombosis most commonly occur?

Answer 20

in legs (deep veins especially)

Question 21

how is cancer a risk factor for venous thrombosis/

Answer 21

trousseau syndrome/ migratory thrombophlebitis

a serine protease released by malignant tumor cells activates factor 10

tumor cells release vesicle with procoagulant activty. tissue thromboplastin is released from necrotic tumor