Prévention des thromboses veineuses Flashcards
[..?] is the only effective rx that interferes with platetlet aggregation for the life of the platelet irreversibly.
Aspirin
effet ad 5 jours!
[…?] also inhibit platelet activity but their effect on prostaglandin synthesis is reversible.
other AINS: indomethacin, sulfinpyrazone, diclofenac
[…]? is generally preferred to PCI (angiocoro percutanée) in cases where the time from xz onset is more than 90 minutes
Thrombolyse
Molécule utilisée pour thrombolyse?
Streptokinase
a non fibrin specific agent with a half-life of 23 min that acts with plasminogen to convert plasminogen to plasmin.
effet x24-36 h
[…] selectively inhibits adenosine diphosphate (ADP)binfing to platelet receptor and subsequent ADP-mediated activation of glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation
Clopidogrel
[…] augments activity of antithrombin III and prevents conversion of fibrinogen to fibrin. Does not actively lyse preformed clot, but is able to inhibit further thrombogenesis after thrombolyse.
Héparine
[…] inhibits cyclooxygénase, which produces thromboxane A2, a potent platelet activator. Early administration has shown to reduce 35-d mortality rate by 23%. An added mortality benefit exists when used in combination with thrombolytics.
Aspirine
Test de l’hémostase primaire?
nb de plaq
test de fonction plaq
test de l’hémostase secondaire?
'’PTT’’ = voie intrinsèque (facteurs, VII, IX, XII)
permet de monitorer héparine
*dilution possible (50/50)
'’PT/INR’’ voie extrinsèque (facteurs VII)
monitoring warfarin
'’TT’’ = mesure le déficit en fibrinogène ou dim activation de prothrombine
TS = overview de tout ça?
gold standard thrombose des MI?
écho doppler
gold standard pour EP?
angio TDM
De facto, un pt a une thrombose au MID
conduite?
déterminer FDR bilan coag ssx néo rx hx d'avortement spontané à répétition diathèse fam
RECHERCHER LA CAUSE SOUS-JACENTE
héparine iv ou HBPM s/c ou warfarin avec pont
*att HIT, chx, voyage, filtre veine cave
