Thrombosis

Question 1

What are the antithrombotic properties?

Answer 1

Antiplatelet - PGI2, NO
Anticoagulant: Heparin like molecule
Fibrinolytic: t-Pa

Question 2

What are prothrombotic properites?

Answer 2

VWF
Tissue factor
Plasminogen activator inhibitors (PAI)

Question 3

What does aspirin inhibit?

Answer 3

activation of platelets by releasing platelet contents.

Question 4

Disseminated Intravascular Coagulopathy

Answer 4

Widespread fibrin thrombo during times fo stress. Pregnancy, shock, infection, malignancy
circulatory deficiency in all organs. consumption of clotting factors/bleeding
CLot and bleeding together

Question 5

wthat is the fate of a thrombus?

Answer 5

1. Propagation
2. Embolization
3. Lysis
4. Organization and recanalization

Question 6

What are the consequences of a Venout Thromboembolism?

Answer 6

Symptomatic DVT/PE
Fatal PE
Increased risk of future VTE
Chronic post thrombotic syndrome

Question 7

What is an infarction?

Answer 7

Ischemic necrosis by occlusion of vessel

99% due to thrombosis, mostly arterial

Question 8

What factors lead to developing an infarct?

Answer 8

1. Vulnerability of tissue to hypoxia
2. O2 content of blood
3. Nature of blood supply
4. Rate of occlusion

Question 9

What phenotype is most likely to be associated with a patient with thrombophilia (inc risk for forming clots)?

Answer 9

Factor V leiden - 40-50%
Prothrombin G201210A - 5-10%
Prot C, Prot S, Antithrombin def - 5%

Question 10

Factor V Leiden

Answer 10

Super bad if homozygous for gene mutation.

If you are taking oral contraceptives with this mutation you risk of TE goes up a ton.

Question 11

When do you evaluate a thromus further?

Answer 11

Young patient, FamHx, Thrombosis in absens of known risk factors, Recurrent miscarriages, Warfarin induced skin necrosis, Neonatal purpura fulminans

Question 12

How do you further eval?

Answer 12

Check levels of:

Factor V leiden, Prothrombin 20210, NOT Homocysteine, Lipoprotein A, Factor VIII/VWF, PAI, Heparin cofactor, Plasminogen

Question 13

What are common inherited Thrombophilias?

Answer 13

def in Antithrombin , Protein C, Protein S, Factor V Leiden
Increased production of Prothrombin G20210A Gene

Question 14

What are characteristics of

Antithrombin III deficiency?

Answer 14

AD, quantitiative, qual, adolescents, PE as presenting feature

Question 15

What are characteristics of Protein C defiency?

Answer 15

AD, Quant, qual, Homozygous die early, Hetero adolescents, skin necrosis when warfarin is introduced

Question 16

What are characteristics of Protein S deficiency?

Answer 16

AD, quant, qual, Homo die because of thrombosis in utero, Thromb in adol
Skin necrosis with warfarin therapy. many lose digits

Question 17

What are characteristics of Factor V leiden ds?

Answer 17

Missens mut in Factor V, slows activation of factor Va by protein C, Procoagulant activity of factor Va is not affected, common. about 50% of all inherited thrombophilias

Question 18

What are the characteristics of Prothrombin G20210A Muation?

Answer 18

Mut in 3’ non coding region of prothrombin gene, no effect on structure or function.
Heterozygotes have a 5-10% higher concentration of prothrombin
Heterozygotes have 2-3x greater risk of VTE
Dx: DNA testing

Question 19

Which of these have more of a long term impact on life?

Answer 19

Prot C, Prot S, and Antithrombin decrease life expectancy the most.
Prothrombin and Factor V leiden decrease life, but not as much