Venous Thrombosis

Question 1

Which, arterial or venous, is a high pressure system?

Answer 1

arterial

Question 2

Are platelets activated in venous thrombosis?

Answer 2

no

Question 3

What is activated in venous thrombosis?

Answer 3

coagulation cascade - fibrin clotting (secondary haemostasis)

Question 4

What is involved in Virchow’s triad?

Answer 4

Stasis
Vessel wall
Hypercoagulability

Question 5

Signs of a DVT?

Answer 5

Limb feels hot, swollen, tender.

Pitting oedema

Question 6

Signs of a PE?

Answer 6

Pulmonary infarction
Pleuritic chest pain
Cardiovascular collapse/death
Hypoxia
Right heart strain

Question 7

Is malignancy a risk factor for Venous Thromboembolism?

Answer 7

yes

Question 8

Is pregnancy a risk factor for Venous Thromboembolism?

Answer 8

yes

Question 9

Is Oestrogen therapy a risk factor for venous thromboembolism?

Answer 9

yes

Question 10

Is pregnancy or puerpium a risk factor for Venous Thromboembolism?

Answer 10

both

Question 11

Is thrombophilia a risk factor for Venous Thromboembolism?

Answer 11

yes

Question 12

Which aspect of VIrschow’s triad is associated with release of tissue factor, raised VWF and factor VIII?

Answer 12

hypercoagulability

Question 13

Does hereditary of acquired Thrombophilia cause venous thrombosis?

Answer 13

both, but acquired (e.g. Antiphospholipid antibody syndrome) has a stronger risk factor for thrombosis than the hereditary thrombophilias

Question 14

When is long term anticoagulation therapy given in patients with hereditary thrombophilia?

Answer 14

if recurrent thrombotic events

Question 15

Why is anticoagulation therapy very risky to give long term?

Answer 15

risk of serious haemorrhage

Question 16

Features of Antiphospholipid Antibody syndrome?

Answer 16

• Recurrent thromboses (Arterial, including TIAs AND Venous)
• Recurrent fetal loss
• Mild thrombocytopenia

Question 17

What is the pathogenesis of antiphospholipid antibody syndrome?

Answer 17

Antibodies lead to a change in β2 glycoprotein 1, which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities.

Question 18

Treatment of antiphospholipid antibody syndrome?

Answer 18

Aspirin

Warfarin