Thrombosis, Embolism, Ischaemia and Infarction Flashcards
What is thrombosis?
Haemostasis which is happening in the wrong place
What stages of the coagulation cascade do newer anticoagulants target?
Propagation and fibrin formation stages (later stages of the cascade)
What factors may result in the patient being in a hypercoagulable state?
Malignancy Pregnancy and peri-partum period Oestrogen therapy Trauma or surgery or lower extremity Inflammatory bowel disease Nephrotic syndrome Sepsis Thrombophilia
What factors can impair blood flow and thus lead to increased likelihood of thrombosis?
Atrial fibrillation left ventricular dysfunction immobility or paralysis venous insufficiency or varicose veins venous obstruction from tumour, obesity or pregnancy
What factors can damage the vessel wall and thus lead to increased likelihood of thrombosis?
trauma or surgery venepuncture chemical irritation heart valve disease or replacement atherosclerosis indwelling catheters
Why is arterial thrombosis known as white thrombus?
It contains many platelets and a small amount go fibrin
Why is venous thrombosis known as red thrombus?
It contains large amounts of fibrin with trapped RBCs present in it
Where does DVT most commonly affect?
The leg
In which part of a vein does a thrombus usually start?
At the valve of the vein
What factors increase the likelihood of DVT?
Impaired vessel walls due to age, surgery, varicose veins
Impaired blood flood due to obesity, pregnancy, immobilisation, IV catheters, external vein compression
Altered composition of blood - thrombophillia, inflammatory conditions, oestrogen hormones
How would you confirm the diagnosis of DVT?
Determine likelihood of DVT
Run blood tests for fibrin D-Dimer
Image the venous system of the leg via ultrasound or venography
What is d-dimer a measure of and why is this tested for if DVT is suspected?
Dissolved thrombus - thus it will be elevated in DVT
What is the name of the scoring system which can be used to assess DVT?
Well’s scoring system
What are the differential diagnoses of a sore leg?
Fractures, dislocation, muscle strain/rupture, haematoma
OA, RA, septic arthritis, gout, popliteal cyst, tenosynovitis, bursitis, myopathies
Cellulitis, erysipleas, abscesses, necrotising fasciitis
DVT, superficial vein thrombosis, venous insufficiency, cardiac thromboembolism, peripheral arterial disease, , lymphedema
If a patient present with bilateral rather than unilateral, sore and swollen legs, how does this impact your thinking of a differential diagnosis?
Think of more systemic causes such as heart failure, cirrhosis, nephrotic syndrome, malnutrition, immobility
Recurrent DVT can cause post thrombotic syndrome. How can the risk of this by reduced?
Wearing compression socks
What are the symptoms of a pulmonary embolism?
Dyspnoea, chest pain, haemoptysis
Give examples of direct Xa inhibitors?
Rivaroxaban, apixaban, edoxaban
Give an example of a direct IIa inhibitor?
Dabigatran
How is DVT treated?
Preventing extension of embolisation of thrombus through anticoagulation - heparin, warfarin, direct oral anticoagulants - for 3-6 months
Removing risk factors
Pain relief
Graduated elastic compression stockings
What are some of the differential diagnoses of chest pain?
Rib fracture, muscular, chondritis Angina, MI Pleuritic pain (infection, infarction, malignant) PE, aortic dissection Acid reflux, hiatus hernia
What causes coronary artery disease?
The development of atheroma which results in progressive narrowing and stenosis of the artery
How can coronary artery disease lead to a MI?
If the plaque ruptures, an acute thrombus can form which causes vascular occlusion and downstream ischaemia and infarction leading to an MI
What are the risk factors for artertiosclertoic cardiovascular disease?
Smoking, hypertension, hyperlipidaemia, diabetes, obesity and family history
