Thrombotic Disorders Flashcards
Venous thrombo-embolism
the process of blood clot formation in the veins
Diagram terminology page
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Provoked Venous thrombo-embolism definition
clear precipitating cause from history or tests
Unprovoked Venous thrombo-embolism definition
no clear cause
Thrombophilia definition
where the blood in the body clots more easily than normal
Why do venous thrombo-embolisms occur? What are the main categories called?
Virchow’s triad
circulatory stasis
vascular injury
hypercoagulable state
Virchow’s triad
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Why do venous thrombo-embolisms occur?: circulatory stasis:
- where the blood is not flowing in the way it
should be - bed rest, hence valves in veins aren’t used
as they should be so blood flow becomes
stagnant, clotting proteins become more
activated and a blood clot forms - lower limb ortho surgery
- major abdominal surgery
- pregnancy
- long haul flights/long car journeys
Why do venous thrombo-embolisms occur?: hypercoagulable states:
- the body is in a state of producing clotting
proteins more than they normal should,
which can activate the clotting processes in
the body - smoking
- oestrogens (oral contraceptives, HRT)
- active cancer
- inherited and acquired thrombophilias
Why do venous thrombo-embolisms occur?: Vascular Injury:
- direct damage to a vessel carrying blood
- limb trauma (including surgery)
- foreign bodies
- cannula, pacemaker wires
- sepsis
- bacteria, toxins
- previous DVT
- May Thurner Syndrome = pinch where iliac
vein and artery overlap so narrowed left
iliac vein due to pressure from right iliac
artery
What is the most common inherited thrombophilia? Related %s.
- Factor V Leiden
- mutation of the factor V gene
- 5% of UK population
- only 10% of people with Factor v Leiden
have thrombosis hence genotype vs
phentotype factors
What is the 2nd most common inherited thrombophilia?
- prothrombin thrombophilia
- mutation of Factor II gene
Other Inherited thrombophilias:
- protein C deficiency
- protein S deficiency
- hereditary anti-thrombin deficiency
- congenital dysfibrogenemia
When to test for inherited thrombophilias?
- if patient has had an unprovoked DVT or
PE and those who have a first degree
relative who has had DVT or PE if it is
planned to stop anticoagulation treatment - do not routinely offer thrombophilia
testing to first degree relative of people
with a history of DVT or PE and
thrombophilia - do not offer testing for hereditary
thrombophilia to people who are
continuing anticoagulation treatment
anyway - do not off thrombophilia testing to people
who have had a provoked DVT or PE
Why do we not test everybody for inherited thrombophilias?
- expensive
- there are many more inherited
thrombophilias than what we can test
them hence do not want to falsely reassure
patients
Acquired Thrombophilias:
- most common?
- is?
- affects men or females more?
- associated with
- risks
- most common is antiphospholipid
syndrome - autoimmune disorder: antibodies attack
phospholipids - more female than men
- 10-15% associated with systemic lupus
erythematous have antiphospholipid
syndrome - increased risk of pregnancy complications:
miscarriage, stillbirth, pre-eclampsia
When to consider testing for antiphospholipid antibodies in patients?
patients who have has an unprovoked DVT or PE if it is planned to stop anticoagulation treatment
