Thrombosis and risk factors of thrombosis

Question 1

what is virchows triad

Answer 1

blood flow, composition of blood and vascular endothelial.

Question 2

what is the primary cause of a arterial thrombosis

Answer 2

atherosclerosis.

Question 3

what is the pathogenesis of a arterial thrombosis

Answer 3

rupture of a atheromatous plaque
endothelial injury
platelet aggregation and platelet thrombi.

Question 4

risk factors for arterial thrombi formation

Answer 4

smoking, hypertension, hypercholesterolaemia, diabetes, family history, obesity, physical inactivity, male and sex.

Question 5

what is the main component of a venous thrombus

Answer 5

fibrin

Question 6

what is the pathogenesis of venous thrombosis

Answer 6

venous stasis

hypercoagubale states.

Question 7

symptoms of DVT

Answer 7

swollen, red, hot to touch, painful, unilateral leg

Question 8

what secondary condition is DVT above the leg likely to present with

Answer 8

Pulmonary embolism

Question 9

symptoms of PE

Answer 9

chest pain, breathlessness and haemotypysis.

Question 10

how can hospital acquired VTE be prevented

Answer 10

risk assessment
prophyalaxis- “Low dose” low molecular weight heparin, fondaparinux
Newer anticoagulants- direct inhibitors of Factor Xa: rivaroxaban, direct thrombin inhibitors : dabigatran

Question 11

how is hospital acquired VTE treated

Answer 11

care pathway- anticoagulant drugs.

If patient is at increased risk of bleeding provide stocking to improve circulation to the legs

Question 12

what are the risk factors of VTE

Answer 12

• Active cancer or cancer treatment
• Age over 60 years
• Critical care admission
• Dehydration
• Known thrombophilias
• One or more significant medical comorbidities
• Surgery
• Major Trauma
• Personal history of VTE
• Use of hormone replacement therapy
• Use of oestrogen-containing contraceptive therapy
• Varicose veins with phlebitis
• Obesity (BMI over 30 kg/m2 )
• Pregnancy and postnatal period
• Immobility
• First degree relative with VTE

Question 13

what molecules does unfractionated heparin work on.

Answer 13

anti thrombin (2 sites) and anti Xa

Question 14

what molecule does LMW heparin bind

Answer 14

anti Xa, and anti thrombin

Factor Xa inhibitor

Question 15

what molecule does Fondaparinux find to

Answer 15

anti Xa

Question 16

what molecule do direct thrombin inhibitors act on

Answer 16

thrombin

Question 17

What does a d-dimer test show

Answer 17

D-dimer breakdown product form fibrin clot.

Indicates that a clot was previously present although it has now been broken down

Question 18

how can a ultrasound help diagnose a thrombus

Answer 18

Look for loss of flow signal, intravascular defects or non collapsing vessels in the venous system.
Vessels with clot will not compress if you apply pressure with the ultrasound probe.

Question 19

what is a spiral/multi sliced CT used for

Answer 19

detect PE

Question 20

what is a VQ scan

Answer 20

radio isotope scan.
Compare radioisotope pattern of a inhaled isotope (ventilation scan), injected isotope (perfusion scan)- this is diagnostic of DVT.

Question 21

treatment plan for a uncomplicated patient with dot

Answer 21

Suspected DVT- single dose LMWH
confirm diagnosis-LMWH for 5 days.
Start warfarin
Start patient-held anti-coagulant book + inpatient warfarin chart

Question 22

which anticoagulants are used as both treatment and prevention of DVT

Answer 22

• Rivaroxaban, Apixaban- direct factor Xa inhibitor
• Dabigatran- diresct thrombin inhibitor.-oral.
• Fondaparinux, LMWH- paraenteral

Question 23

how long is DVT/VTE treated for upon first episode and what medication is typically used

Answer 23

3-6 months.

warfarin

Question 24

what are recurrent episodes Recurrent episodes of VTE.

Answer 24

Treat with long term anticoagulation.

Recurrent episodes of VTE.

Question 25

define thrombophillia

Answer 25

familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis.

Question 26

common inherited thrombophillias

Answer 26

• Antithrombin deficiciency
• Protein C deficiency
• Protein S deficiency
• Activated Protein C resistance/FV Leiden
• Dysfibrinogenaemia- give rise to bleeding, thrombosis or both.
• Prothrombin 20210A

Question 27

acquired thrombophillia

Answer 27

antiphospholipid syndrome

Question 28

clinical features of thrombophillaas

Answer 28

DVT, PE, superficial thrombophlebitis, thrombosis of the cerebral axillary, portal mesenteric veins, arterial thrombosis- unusual to be inherited.
arterial thrombosis- anti phospholipid syndrome
Coumarin induced skin necrosis (Protein C deficiency).
Obstetric complications : fetal wastage (Anti Phospholipid Syndrome)- due to thrombosis in the placental circulation.

Question 29

where is the point mutation in factor V leiden

Answer 29

mutation in factor V gene were activated protein C cleaves factor V.

Question 30

does protein C circulate in a activates or inactive form

Answer 30

inactive

Question 31

what complex activates factor

protein C

Answer 31

thrombin and thrombomodulin

Question 32

where is the point mutation in Prothrombin 20210A

Answer 32

untranslated region of prothrombin gene

increases pro thrombin levels

Question 33

what are common clinical manifestations of antiphospholipid syndrome

Answer 33

• Venous thrombosis or
• Arterial thrombosis or
• Recurrent fetal loss (>2)

Question 34

what is antiphospholipid syndrome seen in connection with

Answer 34

connective tissue disorders.

Question 35

pathogenesis of Antiphospholipid syndrome

Answer 35

immune system produces abnormal antibodies called antiphospholipid antibodies. These target proteins attached to fat molecules (phospholipids), which makes the blood more likely to clot

Question 36

if several miscarriages which thrombophilla is tested for

Answer 36

antiphospholipid antibody