Thrombotic Disorders

Question 1

What is an arterial thrombus look like

Answer 1

White clot

Platelets and fibrin

Question 2

What does arterial thrombus lead too

Answer 2

Coronary thrombosis - MI / UAP
Cerebrovascular - stroke
Peripheral limb ischameia

Question 3

What causes arterial thrombus

Answer 3

Atherosclerosis

Question 4

What does a venous thrombus look like

Answer 4

Red cells and fibrin

Question 5

What does venous thrombus cause

Answer 5

DVT
PE
Intracranial thrombosis
Superficial thrombophlebitis

Question 6

What causes venous thrombosis

Answer 6

Stasis and hypercoagulibltiy

Question 7

What does a microvascular thrombus look like

Answer 7

Platelets +- fibrin

Question 8

What causes microvascular thrombus

Answer 8

DIC

Question 9

What is Virchows triad

Answer 9

Stasis - bed rest / travel
Hypercoagulable - pregnant / trauma
Vessel damage - atherosclerosis

Question 10

What are the RF for arterial thromboembolism

Answer 10

Age
Smoking
Inactive
Hypertension
DM 
Obesity
HYpercholesterol
Anti-phospholipid

Question 11

How do you manage RF for arterial thromboembolism

Answer 11

Lifestyle 
Treat vascular RF 
Thrombolysis if acute 
Antiplatelet / anti-coagulant 
Secondary prevention

Question 12

What are the RF for venous thrombosis

Answer 12

Age 
Inherited thrombophilia 
Pregnancy 
COCP / HRT
Tissue trauma
Immobility
Surgery
Obesity 
Active Cancer
Autoimmune - IBD / SLE
Anti-phospholipid
FH

Question 13

How score to Dx Venous thrombosis

Answer 13

Wells / Geneva

Question 14

How do you Dx venous thrombosis

Answer 14

D-dimer
Doppler USS to look for DVT 
V/Q
- If young as less radiation / pregnant / renal 
- Don't tend to do out of hours 
CT Pulmonary angiogram
- Not if pregnant

Question 15

How do you treat venous thrombosis

Answer 15

TED stockings 
Anti-coagulant -
- LMWH acute
- DOAC / warfarin long term 
Thrombolysis in selected cases - massive PE

Question 16

What are inherited thrombophilia

Answer 16

Factor V leiden = most common
Prothrombin G20210A
Anti-thrombin deficiency
Protein C+S deficiency

Question 17

Is screening recommended

Answer 17

Not in asymptomatic

If present with VTE without a cause then screen for high risk e.g. anti-thrombin

Question 18

What does factor v Leiden cause

Answer 18

Activated protein C resistance
Factor V inactivated more slowly then protein C
Leads to increased risk of VTE

Question 19

Is screening recommended for factor V

Answer 19

No because won’t change management

Put on secondary prevention

Question 20

What is DIC

Answer 20

Coagulation and fibrinolysis dysregulated

Results in widespread clotting (platelet + clotting factors consumed) leading to bleeding

Question 21

What are lab results in DIC

Answer 21

Prolonged APTT, PT and bleeding
Low platelets as increased consumption
Low fibrinogen

Question 22

When does DIC occur

Answer 22

Septicaemia
Trauma
Malignancy 
Haemorrhage 
Eclampsia

Question 23

What does it lead too

Answer 23

Ischaemia
Gangrene
Organ failure

Question 24

When do you transfuse in DIC

Answer 24

Only if active bleeding

Question 25

How do you treat DIC

Answer 25

Treat cause e.g. sepsis 
Resus 
Bloods - clotting screen / FBC - platelet 
Transfuse
- Platelet
- FFP / cyroprecipitate

Question 26

What are acquired causes of thrombophilia

Answer 26

Anti-phosphilipid
OCP
HRT
Any cause of thrombocytosis / polycythaemia