Hereditary and Acquired Thrombotic Disorders

Question 1

In the arteries, ________ are more important for clotting, while in veins _______ are more important.

Answer 1

platelets; clotting factors

Question 2

Again, Virchow’s triad is _________.

Answer 2

the three states that lead to hypercoagulation: altered vessels, venous stasis, and altered coagulability

Question 3

What are lifestyle risk factors for venous thrombosis?

Answer 3

Pregnancy, oral contraceptives, trauma, surgery, immobility, obesity, age (older = more likely), malignancy

Question 4

What are inherited disorders of hypercoagulability?

Answer 4

Factor V Leiden; deficiencies of protein C, protein S, and antithrombin; prothrombin mutations

Question 5

Some symptoms of deep vein thrombosis in the extremities include _________.

Answer 5

swelling, warmth, and duskiness of the leg; can be sudden or gradual; varices due to reliance on alternative pathways

Question 6

Symptoms of pulmonary embolism are ________.

Answer 6

shortness of breath, weakness, fainting, cardiac arrest, tachycardia, cough

Question 7

Embolisms are ___________.

Answer 7

pieces of the thrombus that break off

Question 8

How would you diagnose a DVT or PE?

Answer 8

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

Question 9

How are DVTs and PEs treated?

Answer 9

Heparin treats the acute clot, and warfarin prevents future clots

Question 10

The newer antithrombotic drugs are __________.

Answer 10

Rivaroxaban, apixaban, and endoxaban (all of which target Xa), and Dabigatran (which is an oral thrombin inhibitor)

Question 11

Warfarin is an ___________.

Answer 11

antagonist of the glutamyl carboxylation of the serine protease clotting factors

Question 12

How long should people be on anticoagulants after a thrombotic event?

Answer 12

At least three months (for the first provoked or unprovoked event) and indefinitely for those with cancer, thrombophilia, and second events

Question 13

Factor V Leiden is inherited in a(n) ___________.

Answer 13

autosomal-dominant manner

Question 14

Prothrombin gene mutations are __________.

Answer 14

relatively mild clotting disorders (risk is 2x-3x); they are associated with venous thrombosis

Question 15

Type I antithrombin disorders are __________, while type II disorders are _________.

Answer 15

decreased levels of antithrombin; decreased antithrombin activity

Question 16

Homozygous protein C deficiency is __________; heterozygous is ________.

Answer 16

fatal in infancy; survivable, but presents with thrombi in young adulthood

Question 17

Antiphospholipid antibody syndrome is unique for its presentation of thrombi in ________.

Answer 17

arteries and veins

Question 18

What are the laboratory criteria for antiphospholipid syndrome?

Answer 18

Anticardiolipin antibodies, lupus anticoagulant, and beta-2 glycoprotein-I antibodies

Question 19

The HPI of APS is marked by ________.

Answer 19

vascular thromboses and pregnancy complications

Question 20

Clinical features of APS are ___________.

Answer 20

thrombocytopenia, anemia, transient cerebral ischemia, transverse myelopathy/myelitis, livedo reticularis and migraines

Question 21

Those with APS are treated with __________.

Answer 21

heparin and aspirin indefinitely

Question 22

Aspirin doesn’t work for ___________.

Answer 22

venous thrombi

Question 23

Pulmonary embolism accounts for _______ of hospital deaths.

Answer 23

5%-10%

Question 24

Mortality of pulmonary embolism is ______ without therapy and ______ with.

Answer 24

30%;

Question 25

D-dimers have high ___________.

Answer 25

negative-predictive value (i.e., a low D-dimer indicates no clot is present)

Question 26

What is a drug that blocks the GPIIb/IIIa receptor?

Answer 26

Abciximab

Question 27

Those who are heterozygotes for protein C deficiency are at increased risk of __________ when given warfarin without heparin.

Answer 27

temporary hypercoagulability

Question 28

What are the five known heritable hypercoagulation disorders?

Answer 28

Factor V Leiden, protein C deficiency, protein S deficiency, prothrombin mutations (resulting in increased circulatory prothrombin), and antithrombin deficiency