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Cardiology > Thrombosis and Anticoagulation > Flashcards

Thrombosis and Anticoagulation Flashcards

1
Q

what is thrombosis?

A

blood coagulation inside a vessel

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2
Q

describe appropriate coagulation

A

when blood escapes a vessel, failure of coagulation in this situation leads to bleeding

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3
Q

when can thrombosis occur?

A

arterial circulation: high pressure: platelet rich

venous circulation: low pressure fibrin rich

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4
Q

symptoms of arterial thrombosis in coronary circulation

A

pain in left arm
angina

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5
Q

symptoms of arterial thrombosis in cerebral circulation

A

slurred speech, headaches

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6
Q

symptoms of arterial thrombosis in peripheral circulation

A

pain in leg

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7
Q

symptoms of arterial thrombosis in Superior mesenteric artery

A

belly ache

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8
Q

what are the underlying causes of arterial thrombosis in most cases?

A

–Atherosclerosis
-Inflammatory
-Infective
-Trauma
-Tumours
-Unknown
-Platelet driven

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9
Q

what are the presentations of arterial thrombosis?

A

-Myocardial infarction
-CVA
-Peripheral vascular disease
-Others

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10
Q

what are the treatments for arterial thrombosis in the coronary circulation ?

A

Coronary:
-Aspirin other antiplatelets
-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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11
Q

Why is Fondaparinux used instead of heparin?

A

Fondaparinux- used to prevent clotting
much higher risk of bleeding with heparin than fondaparinux- also has a much higher half life than heparin

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12
Q

what is the treatment of arterial thrombosis in the cerebral circulation?

A

-Aspirin,
-other anti-platelets
Thrombolysis
-Catheter directed treatments
Reperfusion

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13
Q

Why is heparin not used in cerebral circulation?

A

too much bleeding

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14
Q

what is the treatment of arterial thrombosis in other sites?

A

Antiplatelets, statins
Role of anticoagulants evolving
Endovascular vs Surgical

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15
Q

where does deep vein thrombosis occur peripherally?

A

Peripheral –Ileofemoral, femoro-popliteal
between ivc and popliteal vein

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16
Q

what are the non specific symptoms for venous thrombosis?

A

calf pain
chest pain
breathlessness
pulled muscle
groin strain

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17
Q

what are things that can change blood flow in virchows triad?

A

Immobilisation
-Surgery
-Long haul flights
-Trauma

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18
Q

what are things that can change endothelium in virchows triad?

A

Injury – physical, chemical

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19
Q

what are things that can change blood constituents genetically in virchows triad?

A

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

20
Q

what are the components of virchows triad?

A

blood constituents
blood flow
endothelium

21
Q

what are things that can change blood constituents acquired in virchows triad?

A

-Anti-phospholipid syndrome
-Lupus anticoagulant
–Hyperhomocysteinaemia

22
Q

what is the main treatment for venous thrombosis?

A
  • heparin or LMWH
    -Warfarin
  • DOAC- direct oral anti coagulation- only once daily- don’t have to monitor
    -endovascular- catheter inserted into vein
    -surgical - very rare
23
Q

how is venous thrombosis prevented?

A

-Mechanical or chemical thromboprophylaxsis
-Also early mobilisation and good hydration

24
Q

describe heparin

A

heparin is given IV via a canula on a continuous infusion- measured with various ratios/ APTT depending on why given medication
- short half life

25
Q

what does heparin do?

A

-Binds to antithrombin and increases its activity
-Indirect thrombin inhibitor

26
Q

what is the difference with low molecular weight heparin?

A

-smaller molecule, less variation in dose and renally excreted
-Once daily, weight-adjusted dose given subcutaneously
-Used for treatment and prophylaxsis

27
Q

describe warfarin

A
  • orally active
    -Antagonist of vitamin K
    Long half life (36 hours)
28
Q

what does warfarin do?

A

-Prevents synthesis of active factors II, VII, IX and X
-Prolongs the prothrombin time

29
Q

drawbacks of warfarin

A

-Difficult to use,
-Individual variation in dose
-Need to monitor
-Measure INR (international normalised ratio, derived from prothrombin time)

30
Q

describe DOAC

A

Orally active
Directly acting on factor II or X
No blood tests or monitoring
Shorter half lives so bd or od
Not used in pregnancy

31
Q

when is DOAC used?

A

Used for extended thromboprophylasis and treatment of AF and DVT/PE

32
Q

describe fondaparineux

A

Pentasaccharide
Indirect Xa inhibitor

33
Q

what does aspirin do?

A

-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

34
Q

symptoms of DVT

A

leg pain, swelling

35
Q

signs of DVT

A

tenderness, swelling, warmth, discolouration

36
Q

complications of DVT

A

Phlegmasia Alba Dolens and Phlegmasia Cerulae Dolens, PE

37
Q

What are the investigations done for DVT?

A

-D-dimer: normal excludes diagnosis positive does not confirm diagnosis

Ultrasound compression

CT or MR venogram
catheter venogram?

38
Q

DVT treatments

A

-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

39
Q

describe re- canalisation - endovenous

A

Chemical
Mechanical
Mechanico-chemical
Stents

40
Q

how are dvt prevented?

A

Mechanical- hydration and early mobilisation, Compression stockings, Foot pumps

Chemical- LMW Heparin

41
Q

symptoms of pulmonary embolism

A

breathlessness, pleuritic chest pain
symptoms of DVT
risk factors for DVT

42
Q

signs of pulmonary embolism

A

tachycardia, tachypnoea, pleural rub,
Signs of DVT

43
Q

how are pulmonary embolisms treated?

A

Supportive treatment
LMW Heparin
Oral warfarin (INR 2-3)for 6 months
DOAC/NOAC
Treat underlying cause

44
Q

how is PE prevention/

A

Anticoagulation
IVC filters

45
Q
A

Cardiology (17 decks)

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