Venous thrombosis

Question 1

arterial thrombosis treatment

Answer 1

aspirin and other anti-platelet drugs
modify risk factors for atherosclerosis

Question 2

arterial thrombus is platelet rich, true or false

Answer 2

true

Question 3

are platelets activated in venous thrombosis

Answer 3

no

Question 4

venous thrombosis risk factors

Answer 4

Virchow’s triad
- stasis
- vessel wall (valvular damage)
- hypercoagulability

Question 5

venous thrombosis treatment

Answer 5

heparin/warfarin/new oral anticoagulants

Question 6

AF - is antiplatelets or anticoagulants more effective

Answer 6

anticoagulants

Question 7

DVT clinical signs

Answer 7

limb feels hot swollen tender
pitting oedema

Question 8

pulmonary embolism - what type of pain

Answer 8

pleuritic chest pain

Question 9

does pulmonary embolism cause right or left heart strain

Answer 9

right

Question 10

risk factors for venous thromboembolism

Answer 10

Age
Marked obesity
Pregnancy
Puerperium (the period of about six weeks after childbirth)
Oestrogen therapy
Previous DVT/PE
Trauma/Surgery
Malignancy
Paralysis
Infection
Thrombophilia

Question 11

what is hypercoagulability associated with

Answer 11

release of tissue factor, raised VWF and factor VIII

Question 12

thrombophilia

Answer 12

Familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis

Question 13

potential mechanisms of thrombophilia

Answer 13

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

Question 14

what is factor V Leiden

Answer 14

a mutation of one of the clotting factors in the blood.
This mutation can increase your chance of developing abnormal blood clots, most commonly in your legs or lungs.

Question 15

what percentage of population have factor V Leiden

Answer 15

5%

Question 16

what are hereditary thrombophilias

Answer 16

A group of genetic defects in which affected individuals have an increased tendency to develop premature, unusual and recurrent thromboses.

Question 17

hereditary thrombophilia

Answer 17

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

Question 18

who would we screen for hereditary thrombophilia

Answer 18

Venous thrombosis <45 years old
Recurrent venous thrombosis
Unusual venous thrombosis (e.g. upper limb?)
Family history of venous thrombosis
Family history of thrombophilia

Question 19

management of hereditary thrombophilia

Answer 19

Advice on avoiding risk (be careful of multiple risk factors)
Short term prophylaxis
- to prevent thrombotic events during
periods of known risk
Short term anticoagulation
- to treat thrombotic events
Long term anticoagulation
- if recurrent thrombotic events

Question 20

why do some people with hereditary thrombophilia never suffer a thrombosis?

Answer 20

it’s more about an accumulation of risk factors

Question 21

risk of recurrent thrombosis - from highest to lowest

Answer 21

• history of previous thrombosis
• spontaneous thrombosis rather than acquired transient risk factor (e.g. immobility or surgery)
• family history
• thrombophilia screen results

Question 22

is Antiphospholipid antibody syndrome hereditary or acquired

Answer 22

acquired thrombophilia

Question 23

Features of Antiphospholipid Antibody Syndrome

Answer 23

Recurrent thromboses
- Arterial, including TIAs
- Venous
Recurrent fetal loss
Mild thrombocytopenia

Question 24

Antiphospholipid antibodies - pathogenesis

Answer 24

Antibodies lead to 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.

Question 25

Conditions associated with Antiphospholipid Antibodies

Answer 25

Autoimmune Disorders
Lymphoproliferative Disorders
Viral Infections
Drugs
Primary - no obvious underlying cause

Question 26

Treatment of anti-phospholipid syndrome

Answer 26

So there is activation of both primary and secondary haemostasis, Arterial and venous thrombosis, so:

Aspirin
Warfarin

warfarin is the choice though