Thrombosis Flashcards
Which is more likely to be formed of platelets- arterial or venous thrombosis?
Arterial
Which is more likely to be formed of fibrin- arterial or venous thrombosis?
Venous
What is the most common inherited thrombophilia?
Factor V Leiden
In factor V Leiden, a single point mutation has what effect?
Factor V is less efficiently switched off by protein C
What is the most common condition causing acquired thrombophilia?
Anti-phospholipid syndrome
What medication is particularly known for increasing the risk of venous thrombosis?
Combined oral contraceptive pill
If an individual has a recurrence of VTE while on warfarin, what should be done?
Increase INR to 3-4 and continue lifelong
Protein S and protein C are responsible for cleaving and neutralising what clotting factors?
V and VIII
What abnormality may be seen on a full blood count of someone with anti-phospholipid syndrome?
Mild thrombocytopenia
Which thrombophilia may paradoxically be associated with a prolonged APTT?
Anti-phospholipid syndrome
What medication is the first line treatment for the majority of individuals with VTE?
NOACs
What is the first thing to do if you suspect that a patient has a DVT?
Calculate their Well’s score
If a patient has a Well’s score of 2 or more (DVT likely), what is the first line investigation and in what timeframe should it ideally be offered?
Ultrasound within 4 hours
If a patient with suspected DVT undergoes an ultrasound and the result is positive, what should be done next?
Therapeutic dose of anticoagulant
If a patient with suspected DVT undergoes an ultrasound as a first line investigation and it is negative, what should be done next?
D-dimer measurement
If a patient has a Well’s score of 2 or more (DVT likely) but an ultrasound cannot be performed within 4 hours, what should be done?
D-dimer and interim therapeutic dose of anticoagulant
An ultrasound scan must be done in every patient with a Well’s score of 2 or more (DVT likely) within what timeframe?
24 hours
If an individual with a Well’s score of 2 or more (DVT likely) has a negative ultrasound but a positive D-dimer, what should be done?
Offer repeat ultrasound in 6-8 days
If a patient has a Well’s score of 1 or less (DVT unlikely), what is the first line investigation and within what timeframe should it be performed?
D-dimer within 4 hours
If a patient has a Well’s score of 1 or less (DVT unlikely), but a D-dimer cannot be performed within 4 hours, how should the patient be managed?
Interim therapeutic dose of anticoagulation
If a patient has a Well’s score of 1 or less (DVT unlikely), but has positive D-dimers, what investigation should be done next and within what timeframe?
Ultrasound within 4 hours
What are the first line NOACs to be offered to patients with VTE?
Apixaban or rivaroxaban
When should anticoagulation be started in patients with suspected VTE?
As soon as the diagnosis is suspected
If apixaban or rivaroxaban are contraindication, what are the second line options for the treatment of VTE?
LMWH followed by dabigatran, edoxaban or warfarin
NOACs should be avoided in patients with an eGFR of less than what?
15ml/min
How should VTE be treated in patients with anti-phospholipid syndrome?
LMWH followed by warfarin
How long should patients be anticoagulated for following an unprovoked DVT?
6 months
How long should patients be anticoagulated for following a provoked DVT?
3 months
How long should patients be anticoagulated for following a DVT if they have active cancer?
3-6 months
Should a patient with recurrent VTEs be offered thrombophilia screening if they are going to be on lifelong anticoagulation?
No
How should a VTE in pregnancy be treated?
SC LMWH
How can post-thrombotic syndrome be treated?
Elevation and compression stockings
