thrombotic disorders

Question 1

what is virchows triad

Answer 1

stasis, hypercoagubility, weak vessel walls

Question 2

naturally occurring anticoags

Answer 2

antithrombin III, protein C, protein S

Question 3

what is the most commonly inherited thrombophilia

Answer 3

protein C resistance

Question 4

result of factor V leiden

Answer 4

protein c ineffiecient –> factor V not broken down quickly

Question 5

symptoms factor V leiden

Answer 5

unprovoked VTE <45 // FH VTE // unusal sites // recurrent

Question 6

mx factor V leiden

Answer 6

heparin prophlylaxis // if recurrent maybe warfarin

Question 7

symptoms APS

Answer 7

venous + arterial thromboses // recurrent miscarriage // livedo reticularis // (pre-eclampsia. pulm hypertension)

Question 8

bloods + antibody APS

Answer 8

thrombocytopenia (low platelets) // raised APTT // anticardiolipin, anti-B2 glycoprotein

Question 9

what condition is APS assoc with

Answer 9

SLE

Question 10

primary prophylaxis APS (ie no VTE yet)

Answer 10

low dose aspirin

Question 11

secondary thromboprophylaxis APS

Answer 11

life long warfarin

Question 12

INR target secondary prophylaxis APS

Answer 12

first arterial or venous = 2-3 // recurrent venous + on warfarin –> add aspirin –> INR = 3-4

Question 13

complications in pregnancy with APS

Answer 13

miscarriage // IUGR // pre-eclampsia // placental abruption // preterm // VTE

Question 14

mx APS pregnancy

Answer 14

as soon as pregnant = low dose aspirin // first USS = LMWH (stop at 34 weeks)

Question 15

general RF VTE

Answer 15

pregnant // immobile // anaesthetics // central venous catheter (femoral > subclavian) // BMI 35+ // old // dehydrated // varicose veins

Question 16

medications that increase risk of VTE

Answer 16

COCP // HRT ( oestrogen AND progesterone > just oestrogen // raloxifene and tamoxifen // antipsychotics esp onlaznapine

Question 17

in hospital, what patients are high risk for VTE

Answer 17

immobile 3+ days // hip or knee replacement // hip fracture // GA 90+ mins // lower limb + GA 60+ mins //

Question 18

VTE prophylaxis options in hospital

Answer 18

compression stockings // fondaparinux // LMWH eg enoxaparin // unfractionated heparin (if CKD)

Question 19

what medication in women needs to be stopped before surgery

Answer 19

COCP or HRT 4 weeks before

Question 20

VTE prophylaxis post hip

Answer 20

LMWH 10 days –> aspirin 28 days // OR LMWH 28 days + stockings // OR rivaroxaban

Question 21

VTE prophylaxis post knee

Answer 21

aspirin 14 days // OR LMWH 14 days + stockings // OR rivaroxaban

Question 22

prophylaxis fragility pelvis, hip fractor

Answer 22

VTE for 1 month // start LMWH 6-12 hours post op OR fondaparinoux 6 hours post op

Question 23

what criteria is used is someone is having a suspected DVT

Answer 23

wells

Question 24

what wells score indicates DVT is likely

Answer 24

2+

Question 25

what invx is done if DVT is deemed likely + what is done if a positive or negative result is seen

Answer 25

leg USS within 4 hours // positive –> start anticoag // negative –> D-dimer

Question 26

if Ddimer and USS is negative in DVT what should be done

Answer 26

consider alternative diagnosis

Question 27

if USS cannot be performed within 4 hours in DVT what should be done

Answer 27

if DVT likely –> D dimer and give anticoag (DOAC eg apixipan or rivaroxaban)

Question 28

what is done in likely DVT if D-dimer +ive but USS -ive

Answer 28

stop anticoag and repeat USS 6-8 days later

Question 29

if wells score reveals DVT is unlikely what should be done

Answer 29

D-dimer within 4 hours // if not availbe GIVE anticiag

Question 30

if D-dimer +ive in unlikely DVT what shouold be done

Answer 30

USS, if not available GIV anticoag

Question 31

1st line anticoag DVT

Answer 31

DOAC as soon as diagnosis suspected (apivipain or rivaroxiban)

Question 32

2nd line anticoag DVT

Answer 32

LMWH –> dabigatran/ edoxaban // OR LMWH –> warfarin

Question 33

if severe renal impairment (eGFR <15) what anticoag is given in DVT

Answer 33

heparin –> warfarin

Question 34

anticoag in APS

Answer 34

LMWH –> warfarin

Question 35

if VTE is provoked how long is anticoag given

Answer 35

3 months (6 if cancer)

Question 36

what score can assess risk of bleed in DVT once on anticoag

Answer 36

ORBIT

Question 37

in a PE what initial invx always needs to be done

Answer 37

ECG + CXR

Question 38

risk of CTPA in pregnancy

Answer 38

increased risk of maternal breast cancer

Question 39

risk V/Q scanning pregnancy PE

Answer 39

childhood cancer risk

Question 40

d-dimer in pregnancy

Answer 40

not useful as raised in pregnancy

Question 41

mx of high risk VTE flying

Answer 41

maybe compression stockings // v maybe LMWH // no aspirin

Question 42

what is post-thrombotic syndrome

Answer 42

venous flow obstruction + insufficiency –> venous hypertension

Question 43

symptoms post-thrombotic syndrome

Answer 43

painful calves // itch // swelling // varicose veins // venous ulcer

Question 44

advise regarding compression stockings to prevent post-thrombotic syndrome

Answer 44

not recommended

Question 45

mx post-thrombotic syndrome

Answer 45

compression stockings

Question 46

what is Heparin-induced thrombocytopaenia

Answer 46

immune reaction –> antibodies against heparin

Question 47

when does Heparin-induced thrombocytopaenia occur

Answer 47

5-10 days posy treatment

Question 48

symptoms + bloods Heparin-induced thrombocytopaenia

Answer 48

low platelets // INCREASED VTE // skin allergy

Question 49

mx Heparin-induced thrombocytopaenia

Answer 49

direct thrombin inhibitor eg argatroban (or danaparoid)

Question 50

mx heparin overdose

Answer 50

protaimine sulphate