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VTE, AFib, and Arrythmia > Pathophysiology of VTE > Flashcards

Pathophysiology of VTE Flashcards

1
Q

VTE stands for…

A

Venous Thromboembolism

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2
Q

VTE most commonly presents as these two forms…

A

Deep vein thrombosis (DVT) - 2/3
Pulmonary embolism (PE) - 1/3

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3
Q

A venous thrombus differs from an arterial thrombus by the following…

A

Formed without damaging the vessel wall; held together by mostly fibrin, NOT platelets

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4
Q

VTE results from…

Also where does it mainly develop?

A

Clot formation within the venous circulation

Mainly develops in lower extremities, in calf veins

Minority in arm, brain, GI, liver

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5
Q

The venous thrombus from VTE may result in…

A

Obstruction of venous circulation - ischemia
Embolize - travel through bloodstream
Lyse - no symptoms

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6
Q

The two pathways involved in the coagulation cascade are…

A

The intrinsic pathway (damaged surfaces) and extrinsic pathways (external trauma)

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7
Q

The three factors that are exclusive to the intrinsic pathway are…

A

12, 11, and 9

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8
Q

The one factor exclusive to the extrinsic pathway is…

A

7

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9
Q

____ converts factor 9a in the intrinsic pathway to factor 10.

A

8a

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10
Q

____ converts factor 7a in the extrinsic pathway, to factor 10.

A

Tissue factor

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11
Q

The factor that is activated by both intrinsic and extrinsic pathways is…

A

Factor 10 - activated by 9a, and 7a

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12
Q

Factor 10a, combined with 5a, furthers the coagulation cascade by…

What does it help convert? There are two more steps in common pathway

A

Converting prothrombin (2) to thrombin (2a), which causes fibrinogen (1) to convert to fibrin (1a)

RESULTING in fibrin clot

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13
Q

Risk factors for VTE are also known as…

A

Virchow’s Triad

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14
Q

The three components in Virchow’s Triad are…

A

Venostasis
Vessel wall injury
Hypercoagulability

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15
Q

Venostasis can be aggravated by the following:

Virchow’s

A

Prolonged bedrest/immobility
Heart failure (class 3-4)
Atrial fibrilation

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16
Q

Vascular damage can be caused by…

Virchow’s

A

Previous VTE
Bacterial infection - sepsis
Trauma - surgery, implants
Peripheral vascular disease

17
Q

Hypercoaguability can be increased by…

Virchow’s - both inherited and adjustable factors

A

Medications
Malignancy
Inherited thrombophilias
Pregnancy + Post-partum
Increased age, obesity, smoking

18
Q

Some medications that may increase hypercoagubaility are…

A

Estrogen - birth control
SERMS, chemotherapy
Older antipsychotics
Erythropoietin

19
Q

Symptoms of a DVT often include…

Leg related

A

Leg pain + tenderness
Ankle edema and calf swelling
Dilated veins
Dusky discolouration

These symptoms can be seen in other conditions as well; statin use

20
Q

Symptoms of a PE often include…

Chest related

A

Sense of impending doom
Sudden, unexplained SoB, tachypnea, tachycardia
Chest pain, cough
Hemoptysis, fever, cyanosis

21
Q

Post-thrombotic syndrome (PTS) is a complication of DVT, where the patient may experience…

A

Chronic pain, swelling + edema, fatigue, and leg ulcers

22
Q

A possible treatment that may help with post-thrombotic syndrome is…

However, cannot be used in…

A

Compression stockings - ankle to knee, at onset of DVT

CI with ulcers, HF, derm issues, peripheral neuropathy

23
Q

Venous skin ulcers may result as a complication of VTE, due to…

A

Lack of proper blood flow - pooling of blood

24
Q

Chronic thromboembolic pulmonary hypertension may occur as a complication of a PE, which results in…

What medication do they have to be on for life?

A

Scarring of lungs - narrowing of arteries and permanent increase in pulmonary blood pressure, may lead to right-sided heart failure

Anti-coagulation necessary for life

25
Q

A lab value that can help rule in VTE is an increase in…

A

D-Dimer

26
Q

To predict likelihood of DVT or PE, we can use…

A

The Wells Criteria

27
Q

Imaging that can help diagnose VTE include…

A

Compression ultrasonography
CT scan
Ventilation/perfusion scan

28
Q

A goal of treatment that should take priority when considering VTE is…

A

Prevention of initial VTE

29
Q

Other goals of treatment that should be considered, besides initial prevention, include…

A

Resolution of signs and symptoms of VTE
Prevention of extension (DVT to PE)
Prevent hemodynamic collapse or development of complications
Prevent recurrence of VTE

Reduce risk of adverse effects from drug treatment

30
Q

A big challenge of preventing and treating VTE is to balance…

A

Bleed risk vs. clot risk - bleeding is predominant adverse event

Monitoring is key

31
Q

Bleeding rates tend to increase with…

Drug-related

A

Intensity and duration of therapy

32
Q

aPTT measures…

What drug does it test

A

Intrinsic + common pathways of coagulation - longer time = less clotting

Tests heparin

33
Q

PT measures…

What drug does it test

A

Extrinsic and common pathway of coagulation

Heparin

34
Q

PTT differs from aPTT, because…

A

aPTT uses an activator to speed up clotting time, creating a narrower reference range (more sensitive)

35
Q

Anti-Xa tests are used to test efficacy of…

A

LMWH and heparin

36
Q

INR measures anticoagulant activity of…

A

Warfarin

INR is calculated with PT, corrected for lab variation

VTE, AFib, and Arrythmia (2 decks)

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