Thrombosis

Question 1

Describe the formation of an arterial thrombosis

Answer 1

atheroma forms
platelets stick to damaged endothelium and aggregate in response to ADP and TXA2 release
plaque rupture exposes TF
triggers coag cascade and thrombus forms

Question 2

What is an arterial plaque mostly made of?

Answer 2

Cholesterol and platelets

Question 3

What is the treatment of an arterial thrombus?

Answer 3

anti-platelets

Question 4

What lifestyle advice is relevant to arterial thrombus?

Answer 4

Stop smoking
Exercise
Lose weight is appropriate
Cut down on alcohol

Question 5

What does a venous clot mainly consist of?

Answer 5

Fibrin and red cells

Question 6

What are the components of Virchow’s triad?

Answer 6

Stasis
Hypercoag
Vessel wall abnormality

Question 7

Give examples of what would cause stasis

Answer 7

Paralysis
Prolonged hospital stay
Obesity
Surgery

Question 8

Give examples of what would cause hypercoagulability

Answer 8

Pregnancy
Age
OCP use
Surgery
Malignancy
infection

Question 9

Give examples of what could result in a vessel wall abnormality

Answer 9

Valve problems
Prev DVT
Age

Question 10

How does a DVT present?

Answer 10

Hot swollen, tender, pitting oedema, pain

Question 11

How is DVT treated in pregnancy?

Answer 11

LMWH

Question 12

What is a PE?

Answer 12

Embolus from DVT travels to pulmonary vasculature

Question 13

How does PE present?

Answer 13

Pleuritic chest pain
CV collapse
Hypoxia
Right heart strain

Question 14

What do investigations show on PE?

Answer 14

d-Dimer raised

ECG shows T wave inversion in lead III

Question 15

What is thrombophilia?

Answer 15

Abnormal tendency to clot

Question 16

Is secondary or primary haemostasis affected in thrombophilia?

Answer 16

Both

Question 17

When should thrombophilia be considered?

Answer 17

VT <40s
Recurrent VT or miscarriage
VT in abnormal place
AT but no arterial disease

Question 18

Which naturally occurring anti-coags are present in the body?

Answer 18

Anti-thrombin

Protein C and S

Question 19

How are protein C and S activated?

Answer 19

Thrombin binds to thrombomodulin to activate the proteins

Question 20

What does anti-thrombin do?

Answer 20

Switches off thrombin

Question 21

What do protein C and S do?

Answer 21

Inactivates factors V and VIII

Question 22

What is factor V Leiden?

Answer 22

Single nucleotide variation in factor V which makes is less efficiently switched off by protein C and S

Question 23

Where is the prothrombin variant mutation?

Answer 23

In the untranslated region of the prothrombin gene

Question 24

How is anti-thrombin def inherited?

Answer 24

AD

Question 25

How may anti-thrombin def be acquired?

Answer 25

After trauma, surgery and OCP

Question 26

Which anti-coag drug are patients with anti-thrombin def resistant to?

Answer 26

Heparin

Question 27

How are protein C and S defs inherited?

Answer 27

AD

Question 28

What lethal complication can protein C and S def cause?

Answer 28

Neonatal purpura fulminans

Question 29

How is protein C def treated?

Answer 29

Plasma derived protein C given

Question 30

What is the management of a confirmed thrombophilia with no clots?

Answer 30

Avoidance of risk

Lifestyle modification

Question 31

When would short term prophylaxis be given in thrombophilia?

Answer 31

Periods of known risk eg: surgery, pregnancy, long haul flight

Question 32

When would long term prophylaxis be considered in thrombophilia?

Answer 32

Recurrent thromboses

Question 33

Which antibodies are found in anti-phospholipid syndrome

Answer 33

anti-cardiolipin

Lupus anticoag

Question 34

What are the clinical features of anti-phospholipid syndrome?

Answer 34

Mild thrombocytopenia
Recurrent foetal loss
Recurrent thromboses

Question 35

What do the antibodies in anti-phospholipid syndrome do?

Answer 35

Act on beta-2 glycoprotein 1

Leads to activation of primary and secondary haemostasis