1. Surgery, immobility, leg fracture, POP 2. OC pill, HRT, pregnancy 3. Long haul flights 4. Inherited thrombophilia – genetic predisposition (Caucasian)

venous thromboembolism Flashcards by Areej Shahid

what is deep vein thrombosis

a blood clot that develops within a deep vein in the body, usually in the leg.

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3 categories of causes of venous thrombosis

circumstanstial
genetic
acquired

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3 circumstantial causes of venous thrombosis

Surgery
Immobilisation
Long haul flights

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2 genetic causes of venous thrombosis

Factor V Leiden
Antithrombin deficiency

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2 acquired causes of venous thrombosis

Anti-phospholipid syndrome
Lupus anticoagulant

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are symptoms and signs of DVT specific

no they are non specifc

clinical diagnosis is unreliable

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symptoms of DVT

pain, swelling

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signs of DVT

tenderness, swelling, warmth, decolourisation

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risk factors of DVT

Surgery, immobility, leg fracture, POP
OC pill, HRT, pregnancy
Long haul flights
Inherited thrombophilia – genetic predisposition (Caucasian)

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investigations for DVT

D-dimer
Ultrasound compression test
venogram

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does positive D dimer confirm diagnosis

no
Positive does not confirm diagnosis – surgery/ pregnancy/ infection can provide positive D-dimer (useless for inpatients in hospital)

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what does ultrasound compresssio test

proximal veins

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mechanical prevention of DVT

hydration and early mobilisation, compression stockings,
foot pumps

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chemical prevention of DVT

LMW heparin

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DVT treatment

Oral warfarin
LMW (low molecular weight) heparin
DOAC (direct oral anticoagulant)
Compression stockings
Treat underlying cause – malignancy, thrombophilia

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what is Thromboprophylaxis

the prevention of clots forming in the veins.

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what is pulmonary embolism

A blockage in one of the pulmonary arteries in your lungs, often caused by blood clots that travel to the lungs from the legs (DVTs)

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when is a large PE signifcant

haemodynamically significant

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complications of PE

Hypotension, cyanosis, severe dyspnoea, right heart strain/ failure

differential diagnosis of PE

chest pain and shortness of breath

symptoms of PE

Breathlessness
Pleuritic chest pain
Cyanosis
May have signs/ symptoms of DVT

signs of PE

Tachycardia
Tachypnoea
Pleural rub
No signs of alternative diagnosis

initial investgations for PE

CXR (chest X-ray) usually normal

ECG – sinus tachy

Blood gases: type 1 respiratory failure, decreased O2 and CO2

further INVESTIGATIONS for PE

D-dimer: normal excludes diagnosis

Ventilation/ perfusion scan: mismatch defects

Treatment for PE

Similar to treatment for DVT - LMW heparin - DOAC - Treat the cause - If cannot anti-coagulate, consider IVC filter (inferior vena cava)

prevention for PE

Similar to prevention for DVT Early mobilisation and hydration Mechanical mobilisation – foot pumps Chemical – LMW heparin

define thrombosis

The formation of a blood clot in a blood vessel (blood coagulation).

what is a thromboembolism

when a blood clot breaks loose and travels through the bloodstream it’s a thromboembolism

describe thrombosis in artieral circulation

higher pressure – platelet rich

describe thrombosis in venous circulation

low pressure – fibrin rich

what happens if If an arterial thrombosis occurs in the coronary circulation

can lead to a myocardial infarction

what happens if If an arterial thrombosis occurs in the cerebral circulation

stroke

what happens if If an arterial thrombosis occurs in the peripheral circulation

peripheral vascular disease and gangrene.

risk factos for athersclerosis

Smoking Hypertension Diabetes Hyperlipidaemia Obesity/ sedentary lifestyle Stress/ type A personality

how to diagnose MI

History ECG Cardiac enzymes

how to diagnose CVA (cerebrovascular accident):

History and examination CT scan/ MRI

how to diagnose Peripheral vascular disease:

History and examination Ultrasound Angiogram

MI treatment

Aspirin – inhibits platelet function LMW heparin Thrombolytic therapy

stroke treatment

Aspirin or clopidogrel, tiglacor; anti-platelet TPA (tissue plasminogen activator) – generates plasmin, degrades fibrin Treat risk factor

describe drug : heparin

- Glycosaminoglycan - Binds to antithrombin and increases its activity - Indirect thrombin inhibitor - Given by continuous infusion

describe drug : low molecular weight heparin

- Smaller molecule, less variation in dose and renally excreted - Once daily, weight-adjusted dose given subcutaneously - Used for treatment and prophylaxis

describe drug: aspirin

- Inhibits cyclo-oxygenase irreversibly - Acts for lifetime of a platelet, 7-10 days - Inhibits thromboxane formation and hence platelet aggregation

describe drug: warfarin

- Prevents synthesis of active factors II, VII, IX and X - Antagonist of vitamin K - Prolongs the prothrombin time - Long half life – 36 hours

describe drug: direct oral anticoagulant drugs

- Orally active – like aspirin and warfarin - Directly acting on factor II and X - No blood tests or monitoring - Used for extended thromboprophylaxis - Not used in pregnancy