Thrombotic disorders

Question 1

what are the constitutes of an arterial clot?

Answer 1

platelets and fibrin 
mainly platelets ('white clot')

Question 2

what are the risk factors for arterial thrombosis?

Answer 2

age 
smoking 
obesity 
diabetes mellitus 
hypertension 
sedentary lifestyle 
hypercholesterolaemia

Question 3

what is the acute treatment for a thrombotic clot?

Answer 3

thrombolysis (t-PA activate)
anti coagulants i.e. heparin, rivaroxaban (DOAC)
anti platelets i.e. aspirin, clopidogrel

Question 4

what are the constitutes of a venous clot?

Answer 4

fibrin and red cells

‘red thrombus’

Question 5

what are the 2 main locations of a venous clot?

Answer 5

deep vein thrombosis

pulmonary embolism

Question 6

if someone was found to have a visceral venous thrombosis, what could be the cause of this unusually site of clot formation?

Answer 6

acute pancreatitis, biliary tress disease etc

the local inflammation leads to activation of coagulation cascade

Question 7

what is the term for a venous blood clot int he superficial veins?

Answer 7

superficial thrombophlebitis

Question 8

what are the risk factors for venous thrombosis?

Answer 8

increasing age 
immobility 
pregnancy 
hormonal therapy - HRT, OCP
cancer 
surgery 
tissue trauma 
obesity 
systemic disease 
family history (1st degree relative)

Question 9

for how long post-op is a patient risk of thrombosis high?

Answer 9

up to 12 weeks

Question 10

what systemic diseases are associated with increased risk of venous thrombosis?

Answer 10

cancer

myeloproliferative neoplasms

autoimmune diseases;

• IBD
• connective tissue e.g. SLE
• antiphospholipid syndrome (arterial and venous)

Question 11

what is the probability scoring tests for venous thrombosis?

Answer 11

wells score

geneva score

Question 12

if someone presented with symptoms suggestive of a venous thrombosis, how would you investigate?

Answer 12

probability scoring - Wells or Geneva score

if high;

• V/Q scan (PE)
• Doppler (DVT)

if low;
- D-dimer

Question 13

when performing a doppler, how would you identify there is a venous thrombosis?

Answer 13

veins are normally compressible so if it isn’t then there is a clot

Question 14

what imaging modalities would you choose if you suspected a pulmonary embolism?

Answer 14

x-ray to check for other causes i.e. pleural effusion

ventilation perfusion scan
V/Q scan
or
CT pulmonary angiogram

Question 15

after a patient has been treated for a venous thrombosis, how long are the kept on anticoagulants for?

Answer 15

3 months then reassess

Question 16

what is the treatment options for a venous thrombus?

Answer 16

DOAC i.e. rivaroxaban
LMWH i.e. dalteparin
warfarin

Question 17

is a pregnant women was found to have a DVT, what treatment would you give?

Answer 17

LMWH i.e. Dlateparin

Question 18

when would you give thrombolysis for a venous thrombus?

Answer 18

massive PE

Question 19

what is heritable thormbophilia?

Answer 19

an inherited predisposition to venous thrombosis

Question 20

what are the different heritable thrombophilias?

Answer 20

factor V leiden (mutation)
prothrombin 
anti thrombin deficiency 
protein C deficiency 
protein S deficiency

Question 21

when do you screen for heritable thormbophilias?

Answer 21

you don’t screen unless there is a high risk i.e. anti thrombin deficiency

Question 22

what are the constitutes of microvascular thrombus clots?

Answer 22

platelets and/or fibrin

Question 23

what is disseminated intravascular coagulation?

Answer 23

diffuse systemic coagulation activation

coagulation uses up all the clotting factors and platelets which can lead to bleeding

Question 24

in what conditions can DIC occur?

Answer 24

sepsis
malignancy
pre eclampsia

Question 25

what are the complications of DIC?

Answer 25

tissue ischaemia =

• gangrene
• organ failure

Question 26

what are the principles of management for DIC?

Answer 26

the patients prothrombin and APTT may be increased suggesting you have to give coagulation factors due to the bleeding.
but you have to anti- coagulate as this will stop the cascade

Question 27

what is the diagnostic criteria for DIC?

Answer 27

presence of an underlying condition that can cause DIC plus one of the following

• increased prothrombin time
• decreased platelet count
• decreased fibrinogen
• increased D-dimer

Question 28

what presentation is highly suggestive of DIC?

Answer 28

generalised bleeding

3 or more unrelated sites

Question 29

what is the treatment for DIC?

Answer 29

aggressive treatment of underlying condition

• platelet concentrate
• FFP
• heparin
• tissue factor pathway inhibitor
• anti thrombin III
• recombinant factor VII activated on episodic bleeding