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Haematology > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

What are the 2 forms of thrombosis?

A

Arterial

Venous

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2
Q

How does arterial thrombosis present?

A

A result of a high pressure system.

Leads to atherosclerosis, these are platelet-rich areas with a tendency to thrombose.

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3
Q

How is arterial thrombus managed?

A

Aspirin/Other antiplatelets.

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4
Q

What are causative factors of venous thrombosis?

A

Valve deterioration

Stasis

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5
Q

What are the 3 components of Virchow’s triad?

A

Stasis
Endothelial injury
Hypercoaguability

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6
Q

Are venous thromboses full of platelets?

A

No, they are fibrin-rich.

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7
Q

How are venous thromboses treated?

A

Heparin/Warfarin

DOACs

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8
Q

How will DVT present?

A

A hot, tender calf.

Will be swollen.

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9
Q

What is thrombophilia?

A

An inherited condition conveying an increased risk of blood clots.

Due to a lack of natural anticoagulants. Individual will be predisposed to thrombosis.

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10
Q

What is factor V leiden disorder?

A

A disorder in which clotting factor V is not switched off correctly, increasing the risk of thrombosis.

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11
Q

When should hereditary thrombophilia be screened for?

A

under 45s with an unprovoked VT
Recurrent VT
Unusual VT location
Family history

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12
Q

How are hereditary haemophilias managed?

A

Give prophylaxis at times of reduced mobility/increased risk.

Avoid risk factors.

Only give long-term anticoagulation in those with repeated thrombotic events.

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13
Q

What condition is an example of an acquired cause of thrombophilia?

A

Antiphospholipid antibody syndrome

This predisposes to both arterial and venous thrombosis.

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14
Q

How can antiphospholipid antibody syndrome manifest?

A

Recurrent miscarriage

Atherosclerotic disease in young patients.

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15
Q

Which part of haemostasis is affected in arterial thrombosis?

A

Primary haemostasis

There are also vessel wall abnormalities.

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16
Q

Which part of haemostasis is affected in venous thrombosis?

A

Secondary haemostasis

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17
Q

How does antiphospholipid antibody syndrome affect APTT?

A

Will be prolonged.

Looks like anticoagulation is given, despite patient having a raised thrombotic risk.

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18
Q

How is antiphospholipid antibody syndrome treated?

A

Give aspirin (for arterial thrombosis) AND warfarin (for venous thrombosis).

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19
Q

How does warfarin work?

A

Affects coagulation factor synthesis.

Specifically those made by vitamin K - II, VII, IX and X.

20
Q

How does heparin work?

A

Acts to potentiate the body’s natural anticoagulant defences.

21
Q

What is the main complication associated with heparin/warfarin therapy?

A

Bleeding

22
Q

What is the target of anticoagulants?

A

Fibrin clot production.

23
Q

What is the difference between arterial and venous thrombosis?

A

Arterial thrombosis occurs in a high pressure system, whereas venous thrombosis occurs in a low pressure system.

24
Q

What natural anticoagulant is potentiated by heparin?

A

Antithrombin

This acts to maximise the effectiveness of this.

25
Q

What can activate factor Xa?

A

Antithrombin

26
Q

What is the difference between unfractionated heparin and LMWH?

A

Unfractionated heparin acts on antithrombin.

LMWH acts on factor V/Xa.

27
Q

Is monitoring necessary on LMWH?

A

No, can use Xa assay if needed.

28
Q

Is monitoring needed when on unfractionated heparin?

A

Yes, monitor APTT.

29
Q

What is the heparin antidote?

A

Protamine sulphate

This completely reverses unfractionated heparin, with only a partial effect on LMWH.

30
Q

Why is heparin not used long-term?

A

As it is given IV/SC - oral preparations are best long-term.

31
Q

What is required for vitamin K absorption?

A

Bile salts

32
Q

How does warfarin therapy affect protein C and protein S?

A

These have a short half-life, and are reduced in early warfarin therapy - this increases clotting risk during early therapy.

This is why heparin is always given alongside warfarin at the point of initiation for 5-7 days.

33
Q

Where are the clotting factors formed?

A

The liver

34
Q

What is used to measure clotting when taking warfarin?

A

INR

This is a standardised form of the PT.

35
Q

What can be given to reverse warfarin?

A

Vitamin K

Given orally - takes 6 hours to work.

It is indicated if INR > 8.

36
Q

What can be given in those with life-threatening bleeds?

A

Clotting factor concentrates.

Only indicated in an emergency.

37
Q

What do DOACs do?

A

They inhibit factor Xa.

Some inhibit thrombin.

38
Q

What is an example of a DOAC which acts on thrombin?

A

Dabigatran

39
Q

What are examples of DOACs which act on factor Xa?

A

Edoxaban, rivaroxaban and apixaban.

40
Q

What are antiplatelet drugs used to treat?

A

Arterial thrombosis.

These are platelet-rich clots.

41
Q

What is an example of a widely used antiplatelet?

A

Aspirin

42
Q

What is atherosclerosis?

A

Damage of arterial endothelium, with the recruitment of foamy macrophages.

Results in plaque formation.

43
Q

What causes platelets to adhere to ruptured plaques?

A

Von Willebrand factor

44
Q

How does aspirin work?

A

Inhibits cyclooxygenase, preventing the release of thromboxane A2, meaning none of this is released when the platelet is activated.

This prevents effective platelet aggregation.

45
Q

How do clopidogrel and prasugrel work?

A

Block ADP.

46
Q

how long before surgery should antiplatelet agents be stopped?

A

7 days.

This is due to the drug affecting platelets for their full lifespan.

47
Q

In severe bleeding, what can be given?

A

Platelet transfusion

Haematology (20 decks)

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