Venous Thromboembolism Flashcards
Arterial thrombosis
Blood clot in an artery
Risk factors of arterial thrombosis (4)
- smoking
- DM
- obesity
- high cholesterol
Management of arterial thrombosis
Aspirin + other antiplatelet drugs
Venous thrombosis
Blood clot which forms in a vein
Factors that make up virchows triad
Hypercoagulable state
Endothelial injury
Circulatory stasis
Conditions in which you are in a hypercoagulable state (6)
- malignancy
- pregnancy/ peripartum
- oestrogen therapy
- IBD
- sepsis
- thrombophillia
Distal vein thrombosis
DVT of the calves
Proximal vein thrombosis
DVT of the popliteal or femoral vein
What type of venous thrombosis is most likely to embolise
Proximal vein thrombosis
Investigations for DVT
D-dimer and Wells score
Diagnostic tool for DVT
US Doppler leg scan
Investigation for PE if indicated by wells score
CTPA
Alternative to CTPA
V/Q scan
First line initial management of DVT or PE
DOACs - apixaban or rivaroxaban
What is also recommended in massive PE with circulatory failure
Thrombolysis
Secondary prevention of DVT or PE in antiphospholipid syndrome
Warfarin
Secondary prevention of DVT or PE in pregnancy
LMWH
Hereditary thrombophilia
Genetic defects cause an increased tendency to develop thromboses
Give some examples of deficiencies in hereditary thrombophilia
- protein C or S deficiency
- antithrombin deficiency
- prothrombin 20210 mutation
- factor V Leiden
State the 3 possible mechanisms of hereditary thrombophilia
Increased coagulation activity
Decreased fibrinolytic activity
Decreased anticoagulant activity
When should we screen for hereditary thrombophilia
- venous thrombosis <45
- recurrent or unusual activity
- family history
Who is most likely to have antiphospholipid syndrome
Women
Pathophysiology of antiphospholipid syndrome
Antibodies lead to a conformational change in b2 glycoprotein 1 which leads to activation of primary and secondary haemostasis and vessel wall abnormalities
Clinical presentation of antiphospholipid syndrome (3)
- recurrent thrombosis
- recurrent foetal loss
- mild thrombocytopenia
Blood results for a patient with antiphospholipid syndrome (2)
- thrombocytopenia
- prolongation of partial thromboplastin time
Management during pregnancy of patients with antiphospholipid syndrome
LMWH and aspirin
What is the most common inherited thrombophillia
Factor V Leiden
