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J Haem > Thrombosis > Flashcards

Thrombosis Flashcards

1
Q

what is the thrombus made of in arterial thrombosis

A

platelets

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2
Q

when atherosclerotic plaques rupture what is exposed

what does this cause

A

collagen and von Willebrand factor exposed = platelet aggregation and platelet plug formation

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3
Q

why does hypertension and smoking cause increased risk of arterial thrombosis

A

both damage the vessel walls = more susceptible to platelet aggregation

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4
Q

management of arterial thrombosis

A 
anti platelet (aspirin) bc arterial thrombosis = platelet rich thrombus 
decrease risk factors - hypertension, smoking etc
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5
Q

what is the thrombus made of in venous thrombosis

A

fibrin

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6
Q

what are the 3 potential problems that can cause venous thrombosis

A

hypercoagulability
stasis
vessel wall

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7
Q

how does pregnancy/puerperium/COCP increase risk of venous thrombosis

A

estrogen increases clotting factors to decrease risk of bleeding at childbirth

= hypercoagulability

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8
Q

how does thrombophilia increase risk of venous thrombosis

A

coagulation problem (ie no natural anticoags or increased coagulation) = hypercoagulability = fibrin thrombosis

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9
Q

how does paralysis increase risk of venous thrombosis

A

paralysis = immobility = stasis of venous blood

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10
Q

how does long haul flights increase risk of venous thrombosis

A

long haul flights = immobility = stasis of venous blood

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11
Q

how does surgery (lower leg ortho) increase risk of venous thrombosis

A

immobility = stasis of venous blood

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12
Q

how does smoking increase risk of venous thrombosis

A

vessel wall damage

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13
Q

how does previous clot increase risk of venous thrombosis

A

vessel wall damage

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14
Q

Virchow’s triad

A

hypercoagulability
stasis
vessel wall

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15
Q

presentation of DVT

A

unilateral lower limb
hot swollen tender
pitting oedema

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16
Q

differential of DVT

A

cellulitis

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17
Q

why does pitting oedema occur in DVT

A

blood cant get back to heart so fluid leaks into legs

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18
Q

investigations for DVT

A

doppler US

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19
Q

what test can you do to rule out DVT, but isn’t diagnostic bc high in lots of things

A

d-dimers

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20
Q

prevention of DVT if risk factors

A

compression stockings
early mobilization
anti-coags - LMWH

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21
Q

complication of untreated DVT

A

PE

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22
Q

presentation of PE

A

pleuritic chest pain
hypoxia
SOB

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23
Q

ECG of PE

A

S1Q3T3

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24
Q

investigations for PE

A

V/Q scan (looking for mismatch)

ECG - for S1Q3T3

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25
what arrhythmia is a risk factor for venous thrombosis why what can it cause
AF = venous stasis in heart (LA) can cause a stroke if the clot embolises
26
drug management of venous thrombosis
anti-coags (LMWH, warfarin, new anticoags) - bc problem is coagulation, not platelets (like arterieal thrombosis)
27
what is the most common type of thrombophilia
factor V leiden
28
types of thrombophilia other than factor V leiden
prothrombin mutation antithrombin deficiency protein C deficiency protein S deficiency
29
what type of thrombosis (arterial or venous) does thrombophilia cause
venous bc thrombophilia = coagulation problem (ie no natural anticoags or increased coagulation) = fibrin thrombosis
30
recurrent DVTs | Fx
consider thrombophilia
31
management of thrombophilia
avoid DVT risk factors - COCP, smoking | consider long term anti-coag if recurrent
32
how does someone get thrombophilia
hereditary
33
is antiphospholipid syndrome acquired or hereditary
acquired
34
what type of condition is antiphospholipid syndrome
autoimmune
35
is primary or secondary haemostasis the problem in antiphospholipid syndrome hence what type of thrombosis occurs
both primary and secondary haemostasis | = arterial and venous thrombosis
36
management of antiphospholipid syndrome
antiplatelet (aspirin) - to stop primary haemostasis problem AND anticoag (LMWH, warfarin) - to stop secondary haemostasis problem
37
what are the natural anti coagulants that satisfy most peoples need to stop coagulation
antithrombin protein S protein C
38
indications for anti coagulant drugs
venous thrombosis eg DVT | atrial fibrillation - stroke prophylaxis
39
which scoring system to you use to assess risk of stroke in AF
CHA2DS2VAC score
40
side effects of anti coagulants
increased bleeding risk
41
how long before surgery should you stop warfarin
5 days
42
indications for warfarin over NOAC (2)
renal failure | patient scared to try new drugs
43
how does warfarin work
inhibits vit K = decreased activation of clotting factors = decreased coagulation
44
drugs interactions with warfarin (3)
cranberry juice grapefruit alcohol (liver problems)
45
what is the initial effect of warfarin what is the long term effect of warfarin (after a week) clinical significance of this
initially - causes coagulation (decreases protein C and S) long term - causes anti-coagulation put on heparin instead of warfarin if you need immediate effects
46
con of warfarin
needs monitoring, low therapeutic index
47
what happens if warfarin dose too high
bleeding risk
48
what happens if warfarin dose too low
thrombosis risk
49
how do you monitor warfarin dose to make sure its not too high or too low how often
INR - based on PT but comparable between hospitals prothrombin time - measures extrinsic pathway (TF/VIIa) can be weekly or 3 monthly, just depends
50
INR aim for warfarin therapy
x2-3 normal
51
management of bleed caused by warfarin therapy (4 stages depending on how severe and INR)
1 - nothing 2 - stop warfarin 3 - vit K PO- reverse anti coag effects of warfarin (warfarin inhibits vit K) 4 - clotting factors (II, VII, IX, X) form donor blood
52
how fast does giving clotting factors work to helping bleed by warfarin indication for this
immediately!! indicated if life threatening emergency
53
how fast does giving vit K work to helping bleed by warfarin indication for this
6 hours if not life threatening, but high INR
54
how fast does stopping warfarin work to helping bleed by warfarin indication for this
3 days if only minor bleed and INR slightly high
55
indication for heparin over warfarin
when immediate anti coag effects required (warfarin is delayed by 1 week)
56
types of heparin | how are they administered
LMWH SC | unfractionated heparin IV
57
drug class of dalteparin
LMWH
58
is LMWH or unfractionated heparin used more indications for the other why
LMWH used more unfractionated heparin - high risk of bleeding AND thrombosis (eg pregnancy) bc has a short half life (30mins) = if bleeding starts can come of fit quickly
59
do you need to monitor warfarin
yes - INR
60
do you need to monitor LMWH
no
61
do you need to monitor unfractionated heparin
no
62
management of bleed caused by heparin therapy
stop heparin - if unfractionated will be out of system in 30 mins protamine - only if severe bleeding
63
why are NOACs preferred over warfarin
no monitoring needed bc normal therapeutic range | less durg interactions than warfarin
64
what annual check do you need to do if on new anticoags (NOACs)
annual renal function checks
65
contraindications to NOACs
renal failure
66
NOACs | example of oral Xa inhibitor
rivaroxaban the '-Xa bans' block factor Xa (bans it)
67
how does rivaroxaban work
oral Xa inhibitor = blocks Xa = no thrombin formation
68
drug class of rivaroxaban
oral Xa inhibitor class of NOACs
69
what type of thrombosis are anti platelet drugs used for
arterial thrombosis - caused by platelet aggregation
70
aspirin drug class
anti platelet
71
side effects of anti platelets
bleeding risk
72
management of serious bleed caused by anti platelet
stop anti platelet | platelet transfusion
73
how long before surgery should you stop an antiplatelet
1 week | bc life span of platelet is 7-10 days
74
what does aspirin inhibit inside the platelets what does this cause
cyclo-oxygenase decreased prostaglandins decreased platelet aggregation
75
aspirin in directly decreased prostaglandins, what side effect can this cause (2)
GI ulceration | bronchospasm
76
mechanism of clopidogrel what does this cause
ADP receptor antagonist decreased platelet aggregation (need ADP for this)
77
clopidogrel drug class
anti platelet

J Haem (12 decks)

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