Hereditary and Acquired Thrombotic Disorders Flashcards
In the arteries, ________ are more important for clotting, while in veins _______ are more important.
platelets; clotting factors
Again, Virchow’s triad is _________.
the three states that lead to hypercoagulation: altered vessels, venous stasis, and altered coagulability
What are lifestyle risk factors for venous thrombosis?
Pregnancy, oral contraceptives, trauma, surgery, immobility, obesity, age (older = more likely), malignancy
What are inherited disorders of hypercoagulability?
Factor V Leiden; deficiencies of protein C, protein S, and antithrombin; prothrombin mutations
Some symptoms of deep vein thrombosis in the extremities include _________.
swelling, warmth, and duskiness of the leg; can be sudden or gradual; varices due to reliance on alternative pathways
Symptoms of pulmonary embolism are ________.
shortness of breath, weakness, fainting, cardiac arrest, tachycardia, cough
Embolisms are ___________.
pieces of the thrombus that break off
How would you diagnose a DVT or PE?
Look for risk factors in the patient history; check for elevated D-dimer levels (low D-dimers rule out thrombosis); ultrasound the suspected area; CT the lungs
How are DVTs and PEs treated?
Heparin treats the acute clot, and warfarin prevents future clots
The newer antithrombotic drugs are __________.
Rivaroxaban, apixaban, and endoxaban (all of which target Xa), and Dabigatran (which is an oral thrombin inhibitor)
Warfarin is an ___________.
antagonist of the glutamyl carboxylation of the serine protease clotting factors
How long should people be on anticoagulants after a thrombotic event?
At least three months (for the first provoked or unprovoked event) and indefinitely for those with cancer, thrombophilia, and second events
Factor V Leiden is inherited in a(n) ___________.
autosomal-dominant manner
Prothrombin gene mutations are __________.
relatively mild clotting disorders (risk is 2x-3x); they are associated with venous thrombosis
Type I antithrombin disorders are __________, while type II disorders are _________.
decreased levels of antithrombin; decreased antithrombin activity
Homozygous protein C deficiency is __________; heterozygous is ________.
fatal in infancy; survivable, but presents with thrombi in young adulthood
Antiphospholipid antibody syndrome is unique for its presentation of thrombi in ________.
arteries and veins
What are the laboratory criteria for antiphospholipid syndrome?
Anticardiolipin antibodies, lupus anticoagulant, and beta-2 glycoprotein-I antibodies
The HPI of APS is marked by ________.
vascular thromboses and pregnancy complications
Clinical features of APS are ___________.
thrombocytopenia, anemia, transient cerebral ischemia, transverse myelopathy/myelitis, livedo reticularis and migraines
Those with APS are treated with __________.
heparin and aspirin indefinitely
Aspirin doesn’t work for ___________.
venous thrombi
Pulmonary embolism accounts for _______ of hospital deaths.
5%-10%
Mortality of pulmonary embolism is ______ without therapy and ______ with.
30%;
D-dimers have high ___________.
negative-predictive value (i.e., a low D-dimer indicates no clot is present)
What is a drug that blocks the GPIIb/IIIa receptor?
Abciximab
Those who are heterozygotes for protein C deficiency are at increased risk of __________ when given warfarin without heparin.
temporary hypercoagulability
What are the five known heritable hypercoagulation disorders?
Factor V Leiden, protein C deficiency, protein S deficiency, prothrombin mutations (resulting in increased circulatory prothrombin), and antithrombin deficiency
