Thrombotic disorders Flashcards
what are the constitutes of an arterial clot?
platelets and fibrin
mainly platelets ('white clot')what are the risk factors for arterial thrombosis?
age smoking obesity diabetes mellitus hypertension sedentary lifestyle hypercholesterolaemia
what is the acute treatment for a thrombotic clot?
thrombolysis (t-PA activate)
anti coagulants i.e. heparin, rivaroxaban (DOAC)
anti platelets i.e. aspirin, clopidogrel
what are the constitutes of a venous clot?
fibrin and red cells
‘red thrombus’
what are the 2 main locations of a venous clot?
deep vein thrombosis
pulmonary embolism
if someone was found to have a visceral venous thrombosis, what could be the cause of this unusually site of clot formation?
acute pancreatitis, biliary tress disease etc
the local inflammation leads to activation of coagulation cascade
what is the term for a venous blood clot int he superficial veins?
superficial thrombophlebitis
what are the risk factors for venous thrombosis?
increasing age immobility pregnancy hormonal therapy - HRT, OCP cancer surgery tissue trauma obesity systemic disease family history (1st degree relative)
for how long post-op is a patient risk of thrombosis high?
up to 12 weeks
what systemic diseases are associated with increased risk of venous thrombosis?
cancer
myeloproliferative neoplasms
autoimmune diseases;
- IBD
- connective tissue e.g. SLE
- antiphospholipid syndrome (arterial and venous)
what is the probability scoring tests for venous thrombosis?
wells score
geneva score
if someone presented with symptoms suggestive of a venous thrombosis, how would you investigate?
probability scoring - Wells or Geneva score
if high;
- V/Q scan (PE)
- Doppler (DVT)
if low;
- D-dimer
when performing a doppler, how would you identify there is a venous thrombosis?
veins are normally compressible so if it isn’t then there is a clot
what imaging modalities would you choose if you suspected a pulmonary embolism?
x-ray to check for other causes i.e. pleural effusion
ventilation perfusion scan
V/Q scan
or
CT pulmonary angiogram
after a patient has been treated for a venous thrombosis, how long are the kept on anticoagulants for?
3 months then reassess
what is the treatment options for a venous thrombus?
DOAC i.e. rivaroxaban
LMWH i.e. dalteparin
warfarin
is a pregnant women was found to have a DVT, what treatment would you give?
LMWH i.e. Dlateparin
when would you give thrombolysis for a venous thrombus?
massive PE
what is heritable thormbophilia?
an inherited predisposition to venous thrombosis
what are the different heritable thrombophilias?
factor V leiden (mutation) prothrombin anti thrombin deficiency protein C deficiency protein S deficiency
when do you screen for heritable thormbophilias?
you don’t screen unless there is a high risk i.e. anti thrombin deficiency
what are the constitutes of microvascular thrombus clots?
platelets and/or fibrin
what is disseminated intravascular coagulation?
diffuse systemic coagulation activation
coagulation uses up all the clotting factors and platelets which can lead to bleeding
in what conditions can DIC occur?
sepsis
malignancy
pre eclampsia
what are the complications of DIC?
tissue ischaemia =
- gangrene
- organ failure
what are the principles of management for DIC?
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
what is the diagnostic criteria for DIC?
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
what presentation is highly suggestive of DIC?
generalised bleeding
3 or more unrelated sites
what is the treatment for DIC?
aggressive treatment of underlying condition
- platelet concentrate
- FFP
- heparin
- tissue factor pathway inhibitor
- anti thrombin III
- recombinant factor VII activated on episodic bleeding
