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Haematology > Thromboembolism ,DVT > Flashcards

Thromboembolism ,DVT Flashcards

1
Q

What does hypercoagulable state mean

A

A person in this state has a higher than normal tendency to clot due to increased procoagulants or decreased antocoagulants

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2
Q

In what cases will you suspect hypercoagulable state

A
  1. Spontaneous thrombosis without obvious risk factors
  2. A family history of recurrent venous thrombosis at early age
  3. Thrombosis with concomitant risk factor at an early age
  4. Thrombosis at unusual site, i.e vessels in arm or organ
  5. recurrent thrombosis
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3
Q

Balance of coagulation in hypercoagulable state

A

tipped towards thrombosis

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4
Q

Diseases involved in hypercoagulable state

A

Myocardial infarction
Cardiovascular disease
Deep vein thrombosis
Peripheral arterial disease

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5
Q

General areas thrombosis occurs

A

Arterial and venous system

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6
Q

Risk factors for arterial thrombosis

A 
Family history of arterial thrombosis
Male sex
Hypertension
Cigarette smoking
Hyperlipedimea
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7
Q

Risk factors for venous thrombosis

A

Virchow’s triad

Stasis
Hyper coagulopathy
Vessel wall damage

age
sex
obesity

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8
Q

Causes of hypercoagulability disorders

A

Hereditary hemostatic disorders i,e factor 5 leiden

Hereditary and acquired hemostatic disorders i.e raised levels of factor 7,8

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9
Q

How is stasis a risk factor/ what causes stasis

A

Cardiac failure- sluggish flow of blood

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10
Q

Hereditary prothrombotic factors

A

Elevated levels of

Fibrinogen- factor 1
Prothrombin - factor 2

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11
Q

What is factor 5 leiden

A

A mutated form of factor 5, given the name factor 5 leiden which is resistant to cleavage by activated protein c complex

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12
Q

Normal action of factor 5

A

Factor 5 is supposed to be cleaved by protein C ( anticoagulant) in order to stop its procoagulant activity to ensure it doesn’t overwork

A mutation–. resistance…..> Persistent procoagulant activity

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13
Q

Most significant genetic risk factor for thrombosis

A

Factor 5 leiden

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14
Q

Prevalence in caucasians

A

5%

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15
Q

Thrombotic risk for heterozygotes

A

6-8 fold

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16
Q

Thrombotic risk for homozygotes with factor 5 mutation

A

80 times risk

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17
Q

This contributes to risk of thromboembolism

A

Elevated factor 8

Elevated von Willebrand factor - also an independent risk factor for MI or stroke

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18
Q

Inhibitors of hemostasis

A

Protein c, protein s
Tissue factor pathway inhibitor
Antithrombin

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19
Q

Acquired prothrombotic risk factors

A
  1. Central venous catheter used as supportive management by being placed in the vein to keep it patent is an important risk factor for thrombosis
  2. Malignancies. Thromboembolism is a complication of cancer. Chemotherapy as well as complex interaction of factors play a role. Malignancies also cause immunosuppression;–>infection, dehydration(stasis)
  3. Sepsis
  4. Congenital heart dx
  5. hypovoleamia
  6. Trauma/surgery
    7 immobilization
  7. Estrogen containing contraceptives
    9.Steroids
  8. Nephrotic syndrome
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20
Q

Prevalence of CVC related DVT

A

1-70%

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21
Q

Screening test for hypercoagulability

A

FBC, expected to be high and will cause stasis
Myeloproliferative disorders
Shortened PT/APTT
High factor assay
Deficiency in anticoagulants i.e assay for protein C and S

Protein C resistance test

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22
Q

Deep vein thrombosis

A

Formation of blood clot in the deep leg vein which may lead to post thrombotic syndrome

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23
Q

Prevalence im US

A

600.000 cases

24
Q

Prognosis of DVT

A

1 out of 100 people die

25
Q

Risk factors for DVT

A 
Previous DVT
Family History
Recent surgery
greater than 40
Hormone therapy/ oral contraceptives
pregnancy / post partum
Previous or current cancer
limb trauma/ orthopedic procedure
coagulation abnormality
Obesity
26
Q

Symptoms of DVT

A 
Discoloration of legs
Swelling of leg
Calf or leg pain
Warm skin
Visibility of surface veins
Leg fatigue
27
Q

Diagnosis of DVT

A

Serial compression ultrasonography which may be combined with doppler
contrast venography
Plasma D-dimer conc
MRI

28
Q

Anticoagulant drugs for DVT

A

Unfractionated heparin
LMW heparin

Anticoagulant prevents further formation of the clot whiles the body compensates for thrombus already formed. it doesnt lyse thrombus

29
Q

Precautions when using unfractionated heparin

A

Monitor with APTT because you dont want to over/under anticoagulate your patient.

APTT should be 1.5-2.5 times the normal APTT

30
Q

Dosage of unfractionated heparin

A

Continous IV or intermittent subcutaneous, i.e every 12 hrs

31
Q

Advantage of LMW heparin

A

No need to monitor with APTT

Given once a day

32
Q

When bleeding occurs with heparin what do you do

A

Reverse effect with protamine

1mg/100 units

33
Q

Common oral anticoagulant

A

Warfarin

34
Q

How to monitor warfarin

A

With INR

35
Q

Target INR for warfarin in DVT, atrial fibrillation, Pulmonary embolism, cardioversion

A

Ideally 2.5 but between 2-3

36
Q

Target INR for warfarin therapy in recurrent DVT on warfarin, mechanical heart valves, Antiphospholipid syndrome

A

Ideally 3.5 but 3.0-4.0 okay

37
Q

How many hours does it take for warfarin to work

A

72 hrs. it is first procoagulant before becoming anticoagulant.

Starting therapy with just warfarin is not wise due to delay in onset and initial procoagulant activity

38
Q

When starting warfarin therapy do this

A

Give warfarin plus LMW/Unfractionated heparin whose anticoagulant effect starts immediately before warfarins anticoagulant activity can set in after 72 hrs

39
Q

Warfarin preferred to heparin because

A

it is administered orally

40
Q

When someone is on warfarin avid these foods

A

Green leafy vegetables rich in vitamin k. Warfarin is a vitamin K antagonist. Their work ends up cancellimg out

41
Q

What foods can cause INR to shoot up/ potentiate warfarin

A

Citrus fruits

42
Q

Warfarin overdose manifests as

A

High INR

43
Q

If INR is between 3-6 what do you do

A

Ideal is supposed to be 2.5 . I will reduce dose or stop and restart at another time

44
Q

If Ideal INR is 3.5 and INR of patient is 4-6

A

Reduce/stop

Restart when INR less than 5

45
Q

If INR is 6-8 with no bleed

A

Stop and start when INR is less than 5

46
Q

If INR is greater than 8 with no or minor bleed

A

You stop and restart when INR is less than 5

You may give vitamin K

47
Q

If INR is greater than 8 with major bleed

A

Stop warfarin and give fresh frozen plasma, vitamin k, prothrombin complex

48
Q

Under heparin clot resolves in

A

5-14 days

49
Q

Thrombolytic drugs

A

Rarely used except i emergency
Dissolves the clot

eg. streptokinase, urokinase

50
Q

Therapy for thrombosis

A

Surgical embolectomy
Anticoagulant
Antithrombolytic drugs

51
Q

Newer drugs for DVT

A

Heparinoids
Oral Direct FX inhibitor
Oral direct FII inhibitor

52
Q

Post thrombotic syndrome

A

Common complication of DVT treated with anticoagulant alone

53
Q

Pathophysiology of PTS

A

Anticoagulant therapy–> Body tries to dissolve clot–> Destruction in valves of veins–> pooling of blood—> thrombosis can recur

54
Q

DVT can cause

A

Pulmonary embolism

55
Q

Risk of getting pulmonary embolism from DVT is reduced with

A

Early treatment. Chances reduced to 1 percent

Haematology (29 decks)

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