Thrombotic Disorders Flashcards
name the elements of haemostasis
primary haemostasis
blood coagulation
fibrinolysis
name the components of primary haemostasis
vasoconstriction
platelet adhesion
platelet aggregation
name the components of blood coagulation
insoluble fibrin formation
fibrin crosslinking
what converts plasminogen to plasmin?
XII
urokinase
tissue plasminogen activator
name the components of Virchow’s triad and what its for
thrombosis:
stasis, vessel damage, hypercoagulability
when would you be in a hypercoaguable state?
pregnancy
trauma
what makes blood stasis more likely to occur?
best rest
travel
what forms a clot in the arterial system?
platelets and fibrin
what does an arterial thrombus result in?
ischaemia and infarction
arterial thrombi are principally secondary to?
atherosclarosis
name the results of a coronary thrombus
MI
unstable angina
name the results of a cerebrovascular thromboembolism
stroke
transient ischaemia
name the results of peripheral embolism
limb ischaemia
risk factors for arterial thrombi
age smoking sedentary lifestyle hypertension DM obesity hypercholesterolaemia
management of arterial thrombi
o Primary prevention Lifestyle modification Treatment of vascular risk factors o Acute presentation Thrombolysis Antiplatelet/anticoagulant drugs o Secondary prevention
name the components of a venous thrombus
fibrin and red cells
what does venous thrombus result in?
back pressure
what is venous thrombus principally due to?
stasis and hypercoagulability
effects of a VTE
limb deep vein thrombosis PE visceral venous thrombosis intracranial venous thrombosis superficial thrombophlebitis
risk factors for venous thrombus
age pregnancy hormonal therapy - COCP/HRT tissue trauma immobility surgery obesity systemic disease family history
systemic disease and venous thrombosis
cancer myeloproliferative neoplasm (MPN) autoimmune disease - IBD, connective tissue disease (SLE), antiphospholipid syndrome - arterial and venous thrombosis
diagnosis of venous thrombus: pretest probability scoring
Wells score
Geneva score
diagnosis of venous thrombus: lab testing if pretest probability low
D-dimer
diagnosis of venous thrombus: imaging
Doppler US
V/Q scan
CT pulmonary angiogram
aim of management in venous thrombosis
prevent clot extension
prevent clot embolisation
prevent clot recurrent in long term treatment
drugs for treatment of venous thrombosis
anticoagulants - LMWH, coumarins (warfarin), DOACs
thrombolysis
when would you consider thrombolysis in venous thrombosis?
massive PE
heritable thrombophilia is/
an inherited predisposition to venous thrombosis
what problems may cause heritable thrombophilia?
o Common Factor V Leiden Prothrombin G20210A o Rare Antithrombin deficiency Protein C deficiency Protein S deficiency
screening and heritable thrombophilia
- Majority are not predictive of recurrent events
- Screening of asymptomatic family members not recommended
- Limited thrombophilia screening: restricted to high risk heritable thrombophilia (antithrombin deficiency)
microvascular thrombus is a result of?
platelets and/or fibrin
what does microvascular thrombus result in?
diffuse ischaemia
main cause of microvascular thrombus?
disseminated intravascular coagulation
what is DIC?
diffuse systemic coagulation activation
when does DIC occur?
septicaemia
malignancy
eclampsia
what does DIC result in?
gangrene
organ failure
consumption of platelets and clotting factors leading to bleeding
