Venous thrombosis Flashcards
arterial thrombosis treatment
aspirin and other anti-platelet drugs
modify risk factors for atherosclerosis
arterial thrombus is platelet rich, true or false
true
are platelets activated in venous thrombosis
no
venous thrombosis risk factors
Virchow’s triad
- stasis
- vessel wall (valvular damage)
- hypercoagulability
venous thrombosis treatment
heparin/warfarin/new oral anticoagulants
AF - is antiplatelets or anticoagulants more effective
anticoagulants
DVT clinical signs
limb feels hot swollen tender
pitting oedema
pulmonary embolism - what type of pain
pleuritic chest pain
does pulmonary embolism cause right or left heart strain
right
risk factors for venous thromboembolism
Age
Marked obesity
Pregnancy
Puerperium (the period of about six weeks after childbirth)
Oestrogen therapy
Previous DVT/PE
Trauma/Surgery
Malignancy
Paralysis
Infection
Thrombophilia
what is hypercoagulability associated with
release of tissue factor, raised VWF and factor VIII
thrombophilia
Familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis
potential mechanisms of thrombophilia
Increased coagulation activity
-Platelet plug formation
-Fibrin clot formation
Decreased fibrinolytic activity
Decreased anticoagulant activity
what is factor V Leiden
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.
what percentage of population have factor V Leiden
5%
what are hereditary thrombophilias
A group of genetic defects in which affected individuals have an increased tendency to develop premature, unusual and recurrent thromboses.
hereditary thrombophilia
Factor V Leiden
Prothrombin 20210 mutation
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
who would we screen for hereditary thrombophilia
Venous thrombosis <45 years old
Recurrent venous thrombosis
Unusual venous thrombosis (e.g. upper limb?)
Family history of venous thrombosis
Family history of thrombophilia
management of hereditary thrombophilia
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
why do some people with hereditary thrombophilia never suffer a thrombosis?
it’s more about an accumulation of risk factors
risk of recurrent thrombosis - from highest to lowest
- history of previous thrombosis
- spontaneous thrombosis rather than acquired transient risk factor (e.g. immobility or surgery)
- family history
- thrombophilia screen results
is Antiphospholipid antibody syndrome hereditary or acquired
acquired thrombophilia
Features of Antiphospholipid Antibody Syndrome
Recurrent thromboses
- Arterial, including TIAs
- Venous
Recurrent fetal loss
Mild thrombocytopenia
Antiphospholipid antibodies - pathogenesis
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.
