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cardio lectures phase 2 > thrombosis and anticoagluation > Flashcards

thrombosis and anticoagluation Flashcards

1
Q

what is rthrombosis

A

blood coagulation inside a vessel

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2
Q

what should you not confuse thrombosis with

A

when there is appropriate coagluation when blood escapes a vessel, failiure of coagulation in this situation leads to bleeding

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3
Q

how does thrombosis occur in arterial circulation

A

high pressure - platelet rich

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4
Q

how does thrombosis occur in venous circulation

A

low pressure - fibrin rich

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5
Q

where does arterial thrombosis occur anatomically

A
  • coronary circulation
  • cerebral circulation
  • peripheral circulation
  • other territories
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6
Q

symptoms of thrombosis in coronary circulation

A

angina
shoulder pain
left arm pain

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7
Q

symptoms of thrombosis in cerebral circulation

A

slurred speech
weakness

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8
Q

symptoms of arterial thrombosis in peripheral circulation

A

pain in the leg

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9
Q

what other territories can u get arterial thrombosis

A

superior mesenteric artery

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10
Q

etiology of arterial thrombosis

A

atherosclerosis - main one
inflammatory
infective
trauma
tumours
unknown

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11
Q

presentation of arterial thrombosis

A

myocardial infarcation
CVA - stroke
peripheral vascular disease
others

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12
Q

treatment of coronary arterial thrombosis

A

Aspirin and other antiplatelets - first line
– LMWH or Fondaparinux or UFH

– Thrombolytic therapy: streptokinase
tissue plasminogen activator

– Reperfusion – Catheter directed treatments and stents

Aspirin inhibits platelet function
TPA generates plasmin, degrades fibrin

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13
Q

why is fondaparinux used instead of heparin

A

fondaparinux - prevents blood clotting

much higher risk of bleeding from heparin

fondaparinux has much higher half life too

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14
Q

treatment of cerebral arterial thrombosis

A

Aspirin, other anti-platelets - first line

Thrombolysis - for stroke

Catheter directed treatments Reperfusion

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15
Q

why is heparin not used in patients who have had strokes

A

too much bleeding

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16
Q

treatment for arterial thrombosis in other sites

A

• Antiplatelets, statins
• Role of anticoagulants evolving
• Endovascular vs Surgical

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17
Q

anatomy of peripheral venous thrombosis

A

from ileofemoral to femoro-popliteal

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18
Q

non specific signs and symptoms of venous thrombosis

A

calf pain, chest pain, breathless
most common DVT signs

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19
Q

what tests to diagnose venous thrombosis

A

D dimer blood test
it is sensitive but not specific

imaging is usually required

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20
Q

3 components of virchow trials

A

blood flow
endothelium
blood constituents

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21
Q

what can change blood flow

A

immobilisation
surgery
long haul flights
trauma

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22
Q

what can affect endothelium

A

injury - physical, chemical

23
Q

genetic blood constituents

A

• Factor V Leiden (5%)
• PT20210A (3%)
• Antithrombin deficiency • Protein C deficiency
• Protein S deficiency

24
Q

acquired blood constituents

A

• Anti-phospholipid syndrome
• Lupus anticoagulant
• Hyperhomocysteinaemia

25
other blood constituteunts
malignancy oestrogens
26
treatment of venous thrombosis
heparin or LMWH warfarin DOAC endovascular - taken over surgical, catheter inserted into vein which gets rid of clot surgical - very rare
27
main treatment for DVT
DOAC direct oral anti coagluation tablets - dont have to monitor
28
prevention of venous thrombosis
• Mechanical or chemical thromboprophylaxsis • Also early mobilisation and good hydration
29
what does heparin do
binds to antithrombin and increases its activity indirect thrombin inhibitor
30
describe half life of heparin
short half life
31
how to monitor heparin
continuous monitoring with APTT, aim ratio 1.8-2.8 its given by IV, need cannula, continuous infusion
32
describe low molecular weight heparin
easier to give smaller molecule less variation in dose and really excreted once daily, weight adjusted dose given subcutaneously, used for treatment and prophylaxis
33
what does warfarin do
prevents synthesis of active factors II, VII, IX and X prolongs the prothrombin time
34
what is warfarin an antagonist of
vitamin k
35
half life of warfarin
long - 36 hours
36
how to give warfarin
• Difficult to use, - individual variation in dose. • Need to monitor • Measure INR (international normalised ratio, derived from prothrombin time) • Usual target range 2-3, • Higher range 3-4.5
37
describe DOAC
directly acting on factor II or X no blood tests or monitoring orally active shorter half life’s
38
what are DOAC used for
extended thromboprophylasis and treatment of AF and DVT/PE not used in pregnanc
39
describe aspirin
• Inhibits cyclo-oxygenase irreversibly • Act for lifetime of platelet, 7-10 days • Inhibits thromboxane formation and hence platelet aggregation • Used in arterial thrombosis, 75-300 mg od
40
other anti platelets
• Clopidogrel -inhibits ADP induced platelet aggregation by irreversibly binding to the p2y12 receptors • Ticagrelor – p2y12 receptor antagonist • Prasugrel – p2y12 receptor antagonist
41
how many people die of DVT and PE a year in UK
25000
42
DVT diagnosis
• Symptoms: leg pain, swelling • Signs: tenderness, swelling, warmth, discolouration • Complications: Phlegmasia Alba Dolens and Phlegmasia Cerulae Dolens, PE
43
DVT investigatio
• D-dimer: normal excludes diagnosis positive does not confirm diagnosis • Ultrasound compression • CT or MR venogram catheter venogram?
44
DVT treatment
• LMW Heparin (for min 5 days) • Oral warfarin (INR 2-3) for 3-6 months • Or DOAC/NOAC • Compression stockings – symptoms vs PTS • Treat/ seek underlying cause • Spontaneous vs provoked
45
endovenous recannalisation
chemical; mechanical mechanic- chemical stents
46
prevention of DVT
• Mechanical- hydration and early mobilisation, Compression stockings, Foot pumps • Chemical- LMW Heparin
47
SYMOPTOM OF pulmonary embolism
breathlessness, pleuritic chest pain
48
signs of pulmonary embolism
tachycardia, tachypnoea, pleural rub,
49
differential; diagnosis of Pulmonary embolism
Musculoskeletal, Infection, Malignancy, Pneumothorax, Cardiac, GI causes
50
initial investigations for pulmonary embolism
• CXR usually normal • ECG sinus tachy, (QI,SI,TIII) • Blood gases: type 1 resp failure, decreased O2 and CO2 • Mainly done to exclude alternative causes
51
further investigations for pulmonary embolism
D-dimer: normal excludes diagnosis • CTPA spiral CT with contrast, visualise major segmental thrombi
52
treatment of pulmonary embolism
• Supportive treatment • LMW Heparin • Oral warfarin (INR 2-3)for 6 months • DOAC/NOAC • Treat underlying cause
53
prevention of pulmonary embolism
anti coagluation IVC filter

cardio lectures phase 2 (5 decks)

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