Thromboembolism ,DVT Flashcards
When do you consider an hypercoagulable state
Spontaneous thrombosis with no obisous risk factors
Family history of recurrent venous thrombosis at early age
Thrombosis with risk factors at early age
Thrombosis at unusual site (upper extremities , viscera)
Recurrent thrombosis
Why is there balance towards thrombosis in hyper coagulable state
Increase in procoagulant element
Decrease in anticoagulant element
What is a thrombus
Solid mass formed in circulation from blood constituents
Complications of thrombus
Ischemia
Embolization
Can a thrombus be venous or arterial
Yes
What’s virchow triad in venous thrombosis
Stasis
Hypercoagulopathy
Vessel wall damage
Risk factors for venous thrombosis s
Coagulation abnormality Stasis Age Sex Obesity
What are some coagulation abnormalities
Hereditary hemostatic disroders like factor V Leiden
Hereditary or acquired hemostatic disroders raising levels of factors VII, VIII
Condition that can cause blood stasis
Cardiac failure
Protein that can’t cleave in factor V mutation (FV leiden )
Protein C complex
Most common genetic risk factor for thrombosis
FV Leiden
Prevalence in caucasians of FV Leiden
5%
Risk for heterozygotes compared to homozygotes in FV Leiden
6-8 fold for heterozygotes
80 folds for homo
Can elevated FVIII increase risk of thrombosis
Yes
Elevation of this coagulation factor is an indépendant risk factor for MI and stroke
vWF
What are the inhibitors of hemostasis
Tissue factor pathway inhibitor ( TFPI)
Protein C
Protein S
Antithrombin
If there is decrease in anticoagulants elements , what you should expect
Thombrosis
Which medical and supportive management is a risk factor for deep vein thrombosis
Central venous catheter
Why is thromboembolism so common inn cancer
Factors interaction complexity Malignancy Chemotherapy and side effects Increased Infections Increased dehydration
What are some acquired prothrombic conditions
Sepsis Congenital heart diseas Hypovolemia Trauma Surgery Immobilization Estrogen in contraceptives Steroid Nephrotic syndrome
Screen test for thrombotic condition
FBC - elevated PBF - myeloproliferative disorders PR / APTT - shorter Factor assay Activated protein C resistance test in FV Leiden Assay for protein C and S
What is DVT
Formation of blood clot in deep leg vein
May lead to post thrombotic syndrome or PE
Mortality rate of DVT
1/100 person with DVT dies
What condition is called economy class syndrome
DVT
Main location of DVT
Center of leg
DVT risk factors
Previous DVT Family hx Immobilization Recent surgery More than 40 yo Hormone therapy Oral contraceptive Pregnancy Postpartum Previous/ current cancer Limb trauma Coagulation abnormalities Obesity
DVT symptoms
Leg discoloration Calf pain Leg pain Swelling of leg Warm skin Visible surface veins Leg fatigu
Diagnosis technique for DVT
Serial compression USG Doppler Contrast venography Plasma D dimer concentration MRI
Drugs used in DVT
Unfractioned heaprin - continuous IV, or intermittent SC - to monitor with APTT
Low molecular weight heparin - no monitoring
Parentéral Drug given if there is bleeding with heparin
Protamine 1mg/100 units
Oral drugs given in DVT
Warfarin
In which clinical state do you give warfarin with INR 2.5
DVT Pulm Embolism Atrial fibrillation Cardioversion
Clinical state in which warfarin should in INR 3.5
Recurrent DVT
Mechanical heart valves
APS
If warfarin INR is 3-6 what should you do
Reduce dose
Or stop
If warfarin INR is 6-8 or 4-6 what should you do
Stop and Start when <5
If warfarin INR is more than 8 what should you do
Can vit k
Restart when les than 5
If warfarin give major bleeding what should you do
FFP
Vit k
Prothrombin n complex
Other than heparin, what are other the parties available
Thrombolytic therapy with streptokinase/urokinase
Surgical embolectomy in extensive thrombosis
What is post thrombotic syndrome
Complication of DVT treated with anticoagulation alone where clot remain in vein since anticoagulation do not dissolve clot but just prevent their formation
Damage of blood veins by body dissolution of clot
Percentage of people that develops post thrombotic syndrome
60-70%
Can DVT cause pulmonary embolism
Ywa
