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My PANCE Decks > Thrombophilias (Self-made, INC) > Flashcards

Thrombophilias (Self-made, INC) Flashcards

1
Q

What is Virchow’s triad?

A
  • Stasis
  • Vessel Wall Injury
  • Hypercoagulability
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2
Q

What is the pathophysiology behind increased thrombosis risk during infection and inflammation?

A
  • Infection leads to release of procoagulants.
  • Inflammation causes endothelial cell damage, which can activate leukocytes, chemokine release, TNF, etc.
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3
Q

What is thrombophilia more closely associated with in terms of thrombosis etiology?

A

It typically precedes venous thrombosis, but not arterial.

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4
Q

What inherited thrombophilia puts someone most at risk for DVT?

A

Factor V Leiden

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5
Q

What is the diagnostic test for Factor V Leiden?

A

APC test.

Lack of change when Activated Protein C is added = Factor V Leiden

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6
Q

What is the underlying pathophysiology of Factor V Leiden?

A
  • Increased coagulation due to slow inactivation of F5a.
  • Decreased AC due to lack of cleavage product which impairs APC.
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7
Q

What is the gold standard for detecting inherited thrombophilias?

A

DNA Testing

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8
Q

What is the underlying physiology of Prothrombin gene mutations?

A

Increased plasma prothrombin levels.

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9
Q

What is the Protein C & S mnemonic?

A

Clot Stoppers.

AC effect.

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10
Q

What are patients with Protein C deficiency most commonly susceptible to?

A

Warfarin-induced skin necrosis

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11
Q

What is the treatment protocol for warfarin-induced skin necrosis?

A
  1. Stop warfarin
  2. Start Vit K, heparin, Protein C concentrate/FFP
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12
Q

What factors does Protein C deficiency mainly affect?

A
  • F8
  • F5
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13
Q

What are the usual coag studies for a patient with homozygous Protein C deficiency? Heterozygous?

A
  • Heterozygous: Normal
  • Homoygous: similar to DIC, elevated aPTT and PT, low fibrinogen, and thrombocytopenia.
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14
Q

What natural condition can lower Protein S levels?

A

Pregnancy or those on OCPs.

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15
Q

How does antithrombin III deficiency typically manifest?

A

Spontaneous DVT or mesenteric vein thrombosis or related to pregnancy/surgery.

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16
Q

What part of pregnancy puts a patient most at risk for thrombosis?

A

Puerpium

17
Q

Where is a DVT most common in a pregnant woman? Why?

A

DVT most commonly occurs in the left lower extremity due to crossing of the right iliac artery OVER the left iliac vein.

18
Q

What findings are typically associated with suspicion of APS?

A
  • SLE
  • Multiple miscarriages
  • Thrombotic events
  • Livedo Reticularis
  • Libman-Sacks endocarditis
19
Q

What congenital heart defects predisposes someone to DVT?

A
  • PFO
  • ASD
20
Q

What clinical findings suggest DVT?

A
  • Swelling, pain, and discoloration only in the involved extremity.
  • Calf tenderness or along deep medial thigh veins.
  • Potentially warm/erythematous over thrombosis.
21
Q

What is the most specific clinical finding for DVT?

A

Unilateral leg edema > 3m below tibial tuberosity.

22
Q

What Well’s score is high probability for DVT? PE?

A
  • DVT: 3+
  • PE: 4+
23
Q

What is the primary diagnostic test for DVT?

A

Compression Venous US w/ Doppler.

24
Q

What is the primary diagnostic test for a PE?

A

CTPA

CT Pulm Angio

V/Q scan works as well.

25
Q

What is the first-line treatment for DVT?

A
  • Heparin + Warfarin
  • DOAC alone
26
Q

When should an IVC filter be considered for DVT?

A
  • CI to AC or high risk of proximal vein thrombosis/PE.
  • Recurrent thromboembolisms despite AC.
27
Q

What are the initial screening tests for a patient with suspected hypercoagulability?

A
  • Antithrombin
  • Protein C & S
  • Factor V Leiden
  • Prothrombin gene mutation
  • APS antibody
28
Q

How can warfarin and heparin influence screening tests for thrombophilias?

A
  • Warfarin lowers Protein C & S levels (Vit K dependent)
  • Heparin reduces antithrombin levels.
29
Q

What is the general starting dose for warfarin?

A

5mg

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