thrombosis Flashcards
thromboembolism complications
death (5%)
recurrance (20% first 2 years)
thrombophlebitic syndrome (recurrant pain,swelling and ulcers) post thrombotic syndrome (23% at 2 years 11% with stockings)
pulmonary hypertension
inheritied causes of thrombosis
antithrombin deficiency
protein c/s deficiency
factor V leiden
prothrombin G20210A
lupus anticoagulant
coag excess
aquired causes of thrombosis
age obesity
previous dvt pe
immobilisation (surgery flights)
malignancy
pregnancy ,ocp,hrt
antiphospholipid syndrome
PV
MM
thrombocythaemia
which acquired + inherited combination of thrombosis drastically increases risk
OCP and factor V leidein
5x
7x
35x in combination
heparin as an anticoagulant mechanism and complications
immediate therapy
heparin unfractionated IV (need monitoring APTT pregnant women)
LMWH s.c. (does not need monitoring)
pentasachharide s.c. ( a bit of heparin 5 sugars)
all potentiates effect of antithrombin, inactivates thrombin
side effects: bleeding and heparin induced thrombocytopenia
osteoporosis with long term use (osteoclast stimulation osteoblast inhibition)
antidote :protamine sulphate
mechanism of rivaroxaban (apixaban) and dabigatran
anti X-a -rivaroxaban apixaban
anti-IIa - dabigatran direct thrombin inhibitor
oral
immediate acting
useful long term
predictable no monitoring
used for AF and VTE
what is the advantage of using warfarin
only completely revserible
if high INR vitK will reverse in 12H
2 7 9 10 prothombin complex concentrate in a minute
target INR of 2.5 (2-3)
1st episode dvt pe, AF, cardiomyopathy
target INR 3.5 (2.5-3.5)
recurrant dvt/pe, mechanical heart valve , coronary artery graft thrombosis, antiphospholipid
thromboprophylaxis in high risk
LMWH tinzaparin or clexane
TED stockings
flotron (mechanical stockings to increase flow)= reduce stasis
all admissions should be assessed for risk vte
treatment of DVT
start LMWH + warfarin or start DOAC
stop lmwh when INR >2 for 2 days
continue for 3-6months
life threatening PE /limb threatening do not use thrombolytic therapy as risk of haemorrhage is high 4%
which has highest risk of reccurance
idiopathic vte
surgical vte
ocp vte
flight vte
idiopathic
previous PE is also greater RF than previous DVT
29 yr old man collapsed at work following PE, 3month anticoag, what next?
factor5leiden test
daily aspirin
continue long term anticoag
heparin injections for long hall flight
long term anticoagulation
high risk
checking factor5 doesnt change anything
38 yr old woman previous dvt while takinf COCOP 2nd dvt during pregnancy
testing for factorV leidein
HRT
continue long term anticoag
low dose warfarin
factor5 leiden due to increase risk with OCP
67 yr old man DVT weight loss , Lmwh, 3months anticoag
abdo CT scan?
switch to DOAC
swtich to warfarin?
thrombosis idiopathic offer abdo ct for malignancy
