Thrombosis Flashcards
What are the antithrombotic properties?
Antiplatelet - PGI2, NO
Anticoagulant: Heparin like molecule
Fibrinolytic: t-Pa
What are prothrombotic properites?
VWF
Tissue factor
Plasminogen activator inhibitors (PAI)
What does aspirin inhibit?
activation of platelets by releasing platelet contents.
Disseminated Intravascular Coagulopathy
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
wthat is the fate of a thrombus?
- Propagation
- Embolization
- Lysis
- Organization and recanalization
What are the consequences of a Venout Thromboembolism?
Symptomatic DVT/PE
Fatal PE
Increased risk of future VTE
Chronic post thrombotic syndrome
What is an infarction?
Ischemic necrosis by occlusion of vessel
99% due to thrombosis, mostly arterial
What factors lead to developing an infarct?
- Vulnerability of tissue to hypoxia
- O2 content of blood
- Nature of blood supply
- Rate of occlusion
What phenotype is most likely to be associated with a patient with thrombophilia (inc risk for forming clots)?
Factor V leiden - 40-50%
Prothrombin G201210A - 5-10%
Prot C, Prot S, Antithrombin def - 5%
Factor V Leiden
Super bad if homozygous for gene mutation.
If you are taking oral contraceptives with this mutation you risk of TE goes up a ton.
When do you evaluate a thromus further?
Young patient, FamHx, Thrombosis in absens of known risk factors, Recurrent miscarriages, Warfarin induced skin necrosis, Neonatal purpura fulminans
How do you further eval?
Check levels of:
Factor V leiden, Prothrombin 20210, NOT Homocysteine, Lipoprotein A, Factor VIII/VWF, PAI, Heparin cofactor, Plasminogen
What are common inherited Thrombophilias?
def in Antithrombin , Protein C, Protein S, Factor V Leiden Increased production of Prothrombin G20210A Gene
What are characteristics of
Antithrombin III deficiency?
AD, quantitiative, qual, adolescents, PE as presenting feature
What are characteristics of Protein C defiency?
AD, Quant, qual, Homozygous die early, Hetero adolescents, skin necrosis when warfarin is introduced
What are characteristics of Protein S deficiency?
AD, quant, qual, Homo die because of thrombosis in utero, Thromb in adol
Skin necrosis with warfarin therapy. many lose digits
What are characteristics of Factor V leiden ds?
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
What are the characteristics of Prothrombin G20210A Muation?
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
Which of these have more of a long term impact on life?
Prot C, Prot S, and Antithrombin decrease life expectancy the most.
Prothrombin and Factor V leiden decrease life, but not as much
