Venous Thrombosis

Question 1

Virchow’s Triad

Answer 1

Stasis of Blood Flow
Endothelial Injury
Hypercoagulability

Question 2

4 inherited deficiencies

Answer 2

Antithrombin
Protein C
Protein S
Factor V Leiden

Question 3

Acquired Risk Factors of Venous Thrombosis

Answer 3

Age
Obesity
Immobilisation
Surgery
Long Distance Travel
Malignancy
Pregnancy, COCP, HRT
Antiphospholipid syndrome
Polycythaemia
Thrombocythaemia

Question 4

3 Inherited mutations

Answer 4

Prothrombin G20210A
Lupus Anticoagulant
Coag Excess - VIII (10%), II (2%), fibrinogen

Question 5

DVT Prophylaxis

Answer 5

Daily Sub Cut LMWH

TED Stockings

Question 6

Treatment of DVT/PE

Answer 6

LMWH (175 units/kg) and Warfarin
Rivaroxaban
Stopped once INR in therapeutic range 2.5

Question 7

1st VTE with known cause

Answer 7

3 months Warfarin

Question 8

Cancer VTE

Answer 8

3-6 months LMWH

Question 9

1st VTE unknown cause

Answer 9

3-6 months Warfarin

Possibly lifelong

Question 10

1st VTE in thrombophilic patient

Answer 10

3 months warfarin

Possibly Lifelong

Question 11

Recurrent VTE

Answer 11

Lifelong Warfarin

Question 12

Heparin mode of action

Answer 12

Potentiates antithrombin III

Inactivates thrombin and factors 9, 10, 11

Question 13

When should LMWH be monitored?

Answer 13

Pregnancy

Renal failure

Question 14

What must be monitored in Unfractionated heparin

Answer 14

APTT

Question 15

Antidote to heparin

Answer 15

Protamine suplhate

Question 16

Side effects of heparin

Answer 16

Bleeding
Heparin induced thrombocytopenia
Osteoporosis

Question 17

Wafarin mode of action

Answer 17

Inhibits reductase enzyme responsible for regenerating active form of vitamin K.
Inhibits synthesis of factors 2, 7, 9, 10, Proteins C, S, Z

Question 18

Antidote to warfarin

Answer 18

IV Vitamin K/ Factor concentrates

Question 19

Target INR for 1st episode DVT or AF

Answer 19

2.5

Question 20

Target INR for recurrent DVT or mechanical valve

Answer 20

3.5

Question 21

INR 5-8

No Bleeding

Answer 21

Withold few doses
Reduce maintenance
Restart when INR

Question 22

INR 5-8

Minor Bleeding

Answer 22

Stop Warfarin
Vit K slow IV
Restart when INR

Question 23

> 8 No/Minor Bleeding

Answer 23

Stop warfarin
Give Vitamin K
Check INR Daily

Question 24

Majot Bleeding (including intercranial haemorrhage)

Answer 24

Stop Warfarin
Give prothrombin complex concentrate
If PTCC is unavailable give FFP
Give VItamin K IV