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3MB Haematology > Venous Thrombosis > Flashcards

Venous Thrombosis Flashcards

1
Q

What is a VTE?

A

Involves a blood clot (thrombus) developing in the circulation, usually secondary to blood stagnation or hypercoagulable states

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2
Q

When a thrombus develops in a deep vein, it is called a..

A

DVT

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3
Q

What’s a PE?

A

Once a thrombus has developed, it can travel (embolise) from the deep veins, through the right side of the heart and into the lungs, where it becomes lodged in the pulmonary arteries

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4
Q

If the patient has a septal defect in their heart, the thrombus can pass through to the ______ side of the heart and into the systemic circulation. If it travels to the brain, it can cause a large ______

A

If the patient has a septal defect in their heart, the thrombus can pass through to the left side of the heart and into the systemic circulation. If it travels to the brain, it can cause a large stroke

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5
Q

Risk factors for DVT/PE

A

Immobility
Recent surgery
Long haul travel
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia

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6
Q

What are Thrombophilias?

A

Conditions that predispose patients to develop blood clots

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7
Q

Give examples of Thrombophilias

A

Antiphospholipid syndrome
Factor V Leiden
Antithrombin deficiency
Protein C or S deficiency
Hyperhomocysteinaemia
Prothombin gene variant
Activated protein C resistance

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8
Q

What does VTE prophylaxis?

A

Low molecular weight heparin (LMWH), such as enoxaparin

Anti-embolic compression stockings

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9
Q

Contraindications to VTE prophylaxis

A

Active bleeding or existing anticoagulation with warfarin or a DOAC

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10
Q

Contraindications to anti-embolic compression stockings

A

Peripheral arterial disease

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11
Q

DVTs are almost always..

A

Unilateral

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12
Q

Bilateral DVTs suggest..

A

Chronic venous insufficiency or heart failure

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13
Q

What does the clinical picture show?

A

DVT

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14
Q

The calf circumference is measured 10cm below the tibial tuberosity. __________ difference is significant

A

More than a 3cm

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15
Q

Consider a ______________ (e.g., shortness of breath and chest pain) in patients with features of a DVT

A

Pulmonary embolism

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16
Q

What is a Well’s score?

A

Predicts the risk of a patient presenting with symptoms having a DVT or PE. It includes risk factors (e.g., recent surgery) and clinical findings (e.g., unilateral calf swelling over 3cm greater than the other leg).

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17
Q

The Wells score is used when considering deep vein thrombosis. The outcome decides the next step..

A

Likely: perform a leg vein ultrasound

Unlikely: perform a d-dimer, and if positive, perform a leg vein ultrasound

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18
Q

_______________ is the usual first-line imaging investigation for a pulmonary embolism

A

CT pulmonary angiogram (CTPA)

19
Q

In DVT/PE, repeat negative ultrasound scans after 6-8 days if the patient has a..

A

Positive D-dimer and the Wells score suggests a DVT is likely

20
Q

Initial management of DVT/PE

A

Apixaban or rivaroxaban
LMWH (alternative)

Consider catheter-directed thrombolysis in patients with a symptomatic iliofemoral DVT and symptoms <14 days

21
Q

Long term coagulation of DVT/PE

A

DOACs - c.i severe renal impairment, antiphospholipid syndrome and pregnancy

Warfarin - 1st line in antiphospholipid syndrome

LMWH - 1st line pregnancy

22
Q

Long term anti-coagulation is continued for..

A

3 months with a reversible cause (then review)

3-6 months in active cancer (then review)

Long-term for unprovoked VTE, recurrent VTE or an irreversible underlying cause (e.g., thrombophilia)

23
Q

When are inferior vena cava filters used?

A

Used in those unsuitable for anticoagulation or where a PE has occurred whilst already on anticoagulation

24
Q

When patients have their first VTE without a clear cause, NICE recommend..

A

Reviewing the medical history, baseline blood results and physical examination for evidence of cancer

25
Q

In patients with an unprovoked DVT or PE that are not going to continue anticoagulation beyond 3-6 months, NICE recommend considering testing for..

A

Antiphospholipid syndrome
Hereditary thrombophilias

26
Q

What is Budd-Chiari Syndrome?

A

Obstruction to the outflow of blood from the liver caused by thrombosis in the hepatic veins or inferior vena cava

27
Q

Budd-Chiari Syndrome is associated with..

A

Hypercoagulable states (e.g., myeloproliferative disorders)

28
Q

BCS presents with a classic triad of:

A

Abdominal pain
Hepatomegaly
Ascites

29
Q

___________ is the usual imaging investigation for establishing the diagnosis of Budd-Chiari syndrome

A

Doppler ultrasonography

30
Q

Tx for Budd-Chiari syndrome

A

Anticoagulation (LMWH and warfarin)
Endovascular procedures (thrombolysis or angioplasty)
Transjugular intrahepatic portosystemic shunt (TIPS)
Liver transplant

31
Q

What is Virchow’s triad?

A

Stasis
Vessel wall
Hypercoagulability

32
Q

Potential mechanisms of thrombophilia

A

Increased coagulation activity
– Platelet plug formation
– Fibrin clot formation
Decreased fibrinolytic activity
Decreased anticoagulant activity

33
Q

Potential deficiencies in Hereditary thrombophilia

A

Factor V Leiden
Prothrombin 20210 mutation
Antithrombin deficiency
Protein C deficiency
Protein S deficiency

34
Q

______________ has a stronger risk factor for thrombosis than
the hereditary thrombophilias

A

Acquired Thrombophilia - Antiphospholipid antibody syndrome

35
Q

Hypercoagulability is associated with..

A

Release of tissue factor, raised
VWF and factor VIII

36
Q

Pathogenesis antiphospholipid antibodies

A

Conformational change in β2 glycoprotein 1 (a protein
with unknown function in health) which leads to activation of both primary and secondary haemostasis and vessel wall
abnormalities

37
Q

What is antiphospholipid syndrome?

A

Acquired disorder characterised by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia

38
Q

APS may occur as a primary disorder or secondary to other conditions, most commonly..

A

SLE

39
Q

Antiphospholipid syndrome causes a paradoxical rise in..

A

APTT - this is due to an ex-vivo reaction of the lupus anticoagulant autoantibodies with phospholipids involved in the coagulation cascade

40
Q

Venous/arterial thrombosis
Recurrent miscarriages
Livedo reticularis
Pre-eclampsia, pulmonary hypertension

A

APS

41
Q

Ix for APS

A

Anticardiolipin antibodies
Anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
Lupus anticoagulant
Thrombocytopenia
Prolonged APTT

42
Q

Mx for APS in primary thromboprophylaxis

A

Low-dose aspirin

43
Q

Mx for APS in secondary thromboprophylaxis

A

Initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3

Recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4

Arterial thrombosis should be treated with lifelong warfarin with target INR 2-3

3MB Haematology (23 decks)

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