Venous Thrombosis

Question 1

What arterial thrombotic events can occur?

Answer 1

Arterial - coronary, cerebral, peripheral

Venous - Deep vein thrombosis, PE

Question 2

Describe arterial thrombosis?

Answer 2

High pressure system
Artherosclerosis
Platelet rich thrombus

Question 3

How do you treat an arterial thrombosis?

Answer 3

Aspirin and other anti-platelet drugs

Modify risk factors for atherosclerosis

Question 4

Describe venous thrombosis?

Answer 4

Low pressure system
Platelets not activated
Activates coagulation cascade - rich in fibrin clot

Question 5

What is Virchow’s Triad?

Answer 5

Stasis
Vessel wall
Hyeprcoagulability

Question 6

How do you treat a venous thrombosis?

Answer 6

Heparin
Warfarin
New oral anticoagulants

Question 7

What are clinical features of a Deep Vein Thrombosis?

Answer 7

Limbs feel hot, swollen and tender

Pitting Oedema

Question 8

What are features of a Pulmonary Embolism?

Answer 8

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

Question 9

What are risk factors for Venous thrombosis? (11…lol)

Answer 9

Age
Marked obesity
Pregnancy
Puerperium
Oestrogen therapy
Previous DVT/PE
Trauma/surgery
Malignancy
Paralysis
Infection
Thrombophilia

Question 10

What are the components of normal haemostatic system?

Answer 10

Formation of platelet plug (Primary)
Formation of fibrin clot (Secondary)
Fibrinolysis
Anticoagulant defences

Question 11

What is thrombophilia?

Answer 11

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

Question 12

What are potential mechanisms of thrombophilia?

Answer 12

Increased coagulation activity - platelet plug/fibrin clot formation
Decreased fibrinolytic activity
Decreased anticoagulant activity

Question 13

Name some Hereditary thrombohilias? (5)

Answer 13

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

Question 14

Name 3 naturally occurring anticoagulants

Answer 14

Serine Protease Inhibitors
Protein C
Protein S

Question 15

When would you consider hereditary thrombophilia screening?

Answer 15

Venous thrombosis <45 years old
Recurrent venous thrombosis
Unusual venous thrombosis
FHx of venous thrombosis or thrombophilia

Question 16

What is the management of Hereditary Thrombophilia?

Answer 16

Advice on avoiding risk
Short term prophylaxis
Short term anticoagulation
Ling term anticoagulation

Question 17

What is a type of acquired thrombophilia?

Answer 17

Antiphospholipid antibody syndrome

Question 18

What are features of antiphospholipid antibody syndrome?

Answer 18

Recurrent thrombosis - arterial, including TIA’s., venous
Recurrent fetal loss
Mild thrombocytopenia

Question 19

What is the pathogenesis of antiphospholipid antibodies?

Answer 19

Antibodies lead to a conformational change in beta2 glycoprotein 1 which leads to activation of both primary and secondary haemostasis ad vessel wall abnormalities

Question 20

In antiphospholipid syndrome, what are the autoantibodies specific for?

Answer 20

Anionic phospholipids and which prolong phospholipid dependant coagulation tests in vitro (Lupus anticoagulants)

Question 21

What other conditions are associated with antiphospholipid antibodies?

Answer 21

Autoimmune disorders
Lymphoproliferative disorders
Viral infections
Drugs
Primary

Question 22

What are treatments of anti-phospholipd syndrome?

Answer 22

Activation of both primary and secondary haemostasis

Arterial and venous thrombosis - aspirin + warfarin