Venous thrombosis Flashcards
arterial thrombotic events
coronary
cerebra al
peripheral
venous thrombotic events
DVT
PE
arterial thrombosis
high pressure system
atherosclerosis - main underlying problem
platelet rich thrombosis
treatment of arterial thrombosis
aspirin
other anti platelets
modify risk factors
venous thrombosis
low pressure system
platelets not activated
anti coag cascade - rich in fibrin clot
causes of venous thrombosis
virchows triad - stasis, vessel wall, hypercoagubility
treatment of venous thrombosis
heparin/warfarin/new oral anti coags
DVT signs
hot
swollen
tender leg
pitting oedema
PE signs
pulmonary infarction pleuritic chest pain CVS collapse/death hypoxia right heart strain
VTE risk
lifetime risk 2.5%
more common in elderly
RF for venous thromboembolism
age obesity preg puerperium oestrogen therapy pre DVT/PE trauma surgery malig paralysis infection thrombophilia
thrombophilia is what
familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis
mechanisms of thrombophilia
increased coag activity - platelet plug formation, fibrin clot formation
decreased fibrinolytic activity
decreased anticoagulant activity
hereditary thrombophilias
group of genetic defects - increased tendency to develop premature, unusual and recurrent thromboses
what defic in hereditary thrombophilia
factor 5 mutation - leiden PT 20210 mutation antithrombin defic protein C defic protein s defic
hereditary thrombophilia screening
venus thrombosis <45yo recurrent VT unusual VT FH of VT FH of thrombophilia
management of hereditary thrombophilia
advice on risks
short term prophylaxis for known risks
short term anti coag for thrombotic events
long term anti coag if recurrent thrombotic events
risk of recurrent thrombosis
history of prev thrombosis
spontaneous rather than risk related
FH
thrombophilia screen results
acquired thrombophilia
anti phospholipid syndrome
features of anti phos
recurrent thromboses - arterial including TIAS, venous
recurrent fetal loss
mild thrombocytopenia
pathology of anti phos
ABs lead to a conformational change in beta2 glycoprotein 1 which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities
Anti phos ABs
lupus anticoagulants
have specificty for anionic phospholipids and which prolong phospholipid dependant coagulation tests in vitro
conditions assoc with anti phos ABs
AI disorders
lymphoproliferative disorders
viral infections
drugs
treatment of anti phos
aspirin
warfarin
