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KB - Haematology > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

What kind of clot do you get in venous thrombosis?

A

fibrin rich (secondary haemostasis)

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2
Q

What is Virchow’s triad?

A

vessel wall damage (valve damage)
hypercoaguability
stasis

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3
Q

Give 2 examples of venous thromboses.

A

DVT

PE

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4
Q

What are risk factors for venous thrombosis?

A 
age 
obesity 
pregnancy, oestrogen therapy, puerperium 
thrombophilia 
paralysis, immobility after surgery 
infection, malignancy 
previous DVT/PE
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5
Q

What are thrombophilias?

A

usually hereditary disorders

predisposing to thrombosis

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6
Q

What are the mechanisms of thrombophilias?

A

decreased natural anticoagulant activity
decreased fibrinolytic activity
increased coagulation activity

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7
Q

What are the naturally occurring anticoagulants?

A

protein C and S
antithrombin III
without these, you don’t switch off clotting as efficiently

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8
Q

What is an example of a thrombophilia that results in decreased anticoagulant activity?

A

Factor V Leiden

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9
Q

What is Factor V Leiden?

A

polymorphism meaning that protein C and S can’t switch off clotting as well as usual

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10
Q

When do you screen for hereditary thrombophilias?

A

VT <45 years
recurrent VT
unusual VT
family history of recurrent VT or thrombophilia

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11
Q

What is the management of thrombophilias?

A

advice on avoiding risk e.g. OCP
short term prophylaxis in period of known risk e.g. pregnancy
long term anticoagulation - if recurrent VT (have to balance risk of recurrent VT with haemorrhage)

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12
Q

What is an example of an acquired thrombophilia?

A

antiphospholipid antibody syndrome

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13
Q

What are the features of antiphospholipid syndrome?

A

recurrent thromboses

recurrent fetal loss

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14
Q

What is the treatment of antiphosphlipid syndrome?

A

aspirin (anti platelet) and warfarin (anticoagulation)

both as primary and secondary haemostasis is effected

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15
Q

In what type of thrombosis do you give anticoagulation?

A

venous

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16
Q

What are some examples of anticoagulant drugs?

A

warfarin
heparin
rivaroxiban, dabigitran

17
Q

What type of clot do you get in arterial thromboses?

A

platelet rich

18
Q

What is the treatment of arterial thromboses?

A

anti platelet drugs e.g. aspirin, clopidogrel

modify lifestyle

19
Q

How do arterial thromboses form?

A

1 - damage to endothelium, recruitment of ‘foamy’ macrophages rich in cholesterol
2 - cholesterol rich plaque formed
3 - plaques can rupture (more likely in high pressure arteries), platelets recruited causing thrombosis

20
Q

Give some examples of arterial thromboses.

A

MI, stroke

21
Q

What are some risk factors for developing arterial thromboses?

A

hypertension
smoking
high cholesterol
diabetes

22
Q

How can you prevent arterial thromboses?

A 
smoking cessation 
treat hypertension 
treate diabetes 
lower cholesterol 
anti platelet drugs
23
Q

What is the mechanism of action of aspirin?

A 
inhibits cyclooxygenase (COX)
necessary to produce thromboxane A2 (which further stimulates platelet activation)
24
Q

What is the mechanism of action of clopidogrel?

A

ADP receptor antagonist

ADP, thromboxane A2, thrombin further stimulate platelet activation via ADP receptors

25
Q

When should you stop anti platelet therapy before an operation?

A

7 days

26
Q

How does heparin work?

A

potentiates antithrombin

immediate effect

27
Q

How does warfarin work?

A

inhibits vitamin K epoxide reductase

blocks ability of vit K to carboxylate vit K dependent clotting factors
so inhibits factors 2,7,9,10

28
Q

What has to be monitored with warfarin therapy\?

A

INR

29
Q

What can reverse the effects of warfarin?

A

vit K

30
Q

What are the pros and cons of newer anticoagulants?

A

don’t require monitoring
decreased drug interactions
no antidote for reversal

31
Q

What is the mechanism of action of rivaroxiban?

A

direct factor Xa inhibitor (so is apixiban)

32
Q

What is the mechanism of action of dabigatran?

A

direct thrombin inhibitor

33
Q

What is the mechanism of action of dipyramidole?

A

decreased cAMP

34
Q

How do you monitor LMWH?

A

anti Xa assay

35
Q

How do you monitor unfractionated heparin?

A

APTT

36
Q

How can you reverse heparin?

A

protamine sulphate

KB - Haematology (11 decks)

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