Thrombosis basics

Question 1

What is thrombosis?

Answer 1

The coagulation of blood products

Question 2

What is meant by a thrombotic event?

Answer 2

These are events in which there is inappropriate coagulation of blood products

Question 3

What are the 2 main types of thrombosis?

Answer 3

Arterial
Venous

Question 4

What is the difference between a blood clot and a thrombus?

Answer 4

Blood clots are formed outside of the blood vessels and are stationary

Thromboses are formed within the blood vessels and can be mobile

Question 5

What is Virchow’s triad of conditions under which thrombosis can most likely occur?

Answer 5

Stasis
Vessel wall damage
Hyper-coagulability

Question 6

How do arterial thromboses form?

Answer 6

This is a high pressure system, meaning that blood contents such as cholesterol, can be pushed into the vessel wall causing wall damage, therefore increasing risk of thrombosis

Question 7

Describe the components of an arterial thrombus

Answer 7

Arterial thromboses are platelet rich as the pressure is too high for the coagulation cascade to activate

Question 8

What are some common locations for arterial thromboses?

Answer 8

• Coronary - Myocardial infarction
• Cerebral - Stroke
• Peripheral - gangrene

Question 9

What is the main treatment option in arterial thrombosis?

Answer 9

Anti-platelet drugs such aspirin
Management of the cause (e.g. statins in atherosclerosis)

Question 10

What is the most common cause of arterial thrombosis?

Answer 10

Atherosclerosis is the most common example of arterial thrombosis in which a thrombus forms over the atherosclerotic plaque

Question 11

How do venous thromboses form?

Answer 11

This is a low pressure system, meaning that there is more stasis, meaning that the coagulation cascade can be activated forming a fibrin rich clot

Platelets are not usually activated as there is no injury of the endothelium

Question 12

What are the 2 main complications of venous thrombosis?

Answer 12

Deep Vein Thrombosis (DVT)
Pulmonary Embolism (PE)

Question 13

What are some risk factors of venous thrombosis that cause stasis? (7)

Answer 13

Age
Obesity
Pregnancy
Trauma
Malignancy
Atrial fibrillation
Paralysis

Question 14

What are some risk factors of venous thrombosis that cause hyper-coagulability? (9)

Answer 14

Age
Pregnancy
Puerperium (6 weeks post-partum - greatest risk of thrombosis in pregnancy)
Oestrogen therapy
Oral contraceptive
Trauma
Malignancy
Infection
Renal failure
Thrombophilia

Question 15

How can malignancy increase hyper-coagulability?

Answer 15

Tumours produce TF, mucin and cytokines, which all activate coagulation

Also, chemotherapeutic agents can injure endothelium and lead to thrombosis

Question 16

How does renal failure lead to hyper-coagulability?

Answer 16

Renal failure can lead to nephrotic syndrome, which can allow regulatory proteins to escape blood and into urine

Question 17

What are some risk factors of venous thrombosis that cause vessel wall damage?

Answer 17

Smoking
Age
Previous DVT/PE
Diabetes

Question 18

What are the main treatment options in venous thrombosis?

Answer 18

Heparin
Warfarin
DOACs