Thrombotic Disorders Flashcards
What is an arterial thrombus look like
White clot
Platelets and fibrin
What does arterial thrombus lead too
Coronary thrombosis - MI / UAP
Cerebrovascular - stroke
Peripheral limb ischameia
What causes arterial thrombus
Atherosclerosis
What does a venous thrombus look like
Red cells and fibrin
What does venous thrombus cause
DVT
PE
Intracranial thrombosis
Superficial thrombophlebitis
What causes venous thrombosis
Stasis and hypercoagulibltiy
What does a microvascular thrombus look like
Platelets +- fibrin
What causes microvascular thrombus
DIC
What is Virchows triad
Stasis - bed rest / travel
Hypercoagulable - pregnant / trauma
Vessel damage - atherosclerosis
What are the RF for arterial thromboembolism
Age Smoking Inactive Hypertension DM Obesity HYpercholesterol Anti-phospholipid
How do you manage RF for arterial thromboembolism
Lifestyle Treat vascular RF Thrombolysis if acute Antiplatelet / anti-coagulant Secondary prevention
What are the RF for venous thrombosis
Age Inherited thrombophilia Pregnancy COCP / HRT Tissue trauma Immobility Surgery Obesity Active Cancer Autoimmune - IBD / SLE Anti-phospholipid FH
How score to Dx Venous thrombosis
Wells / Geneva
How do you Dx venous thrombosis
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
How do you treat venous thrombosis
TED stockings Anti-coagulant - - LMWH acute - DOAC / warfarin long term Thrombolysis in selected cases - massive PE
What are inherited thrombophilia
Factor V leiden = most common
Prothrombin G20210A
Anti-thrombin deficiency
Protein C+S deficiency
Is screening recommended
Not in asymptomatic
If present with VTE without a cause then screen for high risk e.g. anti-thrombin
What does factor v Leiden cause
Activated protein C resistance
Factor V inactivated more slowly then protein C
Leads to increased risk of VTE
Is screening recommended for factor V
No because won’t change management
Put on secondary prevention
What is DIC
Coagulation and fibrinolysis dysregulated
Results in widespread clotting (platelet + clotting factors consumed) leading to bleeding
What are lab results in DIC
Prolonged APTT, PT and bleeding
Low platelets as increased consumption
Low fibrinogen
When does DIC occur
Septicaemia Trauma Malignancy Haemorrhage Eclampsia
What does it lead too
Ischaemia
Gangrene
Organ failure
When do you transfuse in DIC
Only if active bleeding
How do you treat DIC
Treat cause e.g. sepsis Resus Bloods - clotting screen / FBC - platelet Transfuse - Platelet - FFP / cyroprecipitate
What are acquired causes of thrombophilia
Anti-phosphilipid
OCP
HRT
Any cause of thrombocytosis / polycythaemia
