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Haematology > Venous Thrombosis > Flashcards

Venous Thrombosis Flashcards

1
Q

What is involved in arterial thrombosis?

A

High pressure system
Atherosclerosis
Platelet rich thrombus

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2
Q

How is arterial thrombus treated?

A

Aspirin and other anti platelet drugs

Modify RFs for atherosclerosis

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3
Q

What is involved in venous thrombosis?

A

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

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4
Q

What is Virchow’s triad?

A

Stasis
Vessel wall- endothelial injury
Hypercoagulability

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5
Q

How is venous thrombosis treated?

A

Heparin/warfarin/ new oral anticoagulants

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6
Q

What are the clinical features in DVT?

A

Limbs feel hot, swollen, tender

Pitting oedema

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7
Q

What can a PE cause?

A 
Pulmonary infarction
Pleuritic chest pain
Cardiovascular collapse/death
Hypoxia
Right heart strain
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8
Q

What is the risk of having a VTE?

A

1/1000/annum
Young adults 1/10000/annum
Elderly 1/100/annum
Lifetime risk 2.5%

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9
Q

What are RFs for VTE?

A 
Age
Marked obesity
Pregnancy
Puerperium
Oestrogen therapy
Previous DVT/PE
Trauma/Surgery
Malignancy
Paralysis
Infection
Thrombophilia
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10
Q

What RFs are associated with stasis?

A 
Age
Marked obesity
Pregnancy
Previous DVT/PE
Trauma/surgery
Malignancy
Paralysis
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11
Q

What RFs are associated with vessel wall injury?

A

Age

Previous DVT/PE

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12
Q

What RFs are associated with hypercoagulability?

A 
Age
Pregnancy
Puerperium
Oestrogen therapy
Trauma/surgery
Malignancy
Infection
Thrombophilia
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13
Q

What are the RFs related to hypercoagulability associated with?

A

Release of TF, raised vWF and factor VIII

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14
Q

What is thrombophilia?

A

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

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15
Q

What are the possible mechanisms of thrombophilia?

A

Increased coagulation activity- Platelet plug formation, fibrin clot formation
Decreased fibrinolytic activity
Decreased anticoagulant activity

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16
Q

What are the hereditary thrombophilias?

A

A group of genetic defects in which affected individuals have an increased tendancy to develop premature, unusual and recurrent thromboses

17
Q

What can cause a hereditary thrombophilia?

A 
Factor V Leiden
Prothrombin 20210 mutation
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
18
Q

When should you consider hereditary thrombophilia screening?

A 
Venous thrombosis <45 years old
Recurrent venous thrombosis
Unusual venous thrombosis
Family history of venous thrombosis
Family history of thrombophilia
19
Q

How should you manage hereditary thrombophilia?

A

Advice on avoiding risk
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

20
Q

How should risk of recurrent thrombosis be evaluated?

A

History of previous thrombosis
Spontaneous thrombosis rather than acquired transient risk factor (eg immobility or surgery)
Family history
Thrombophilia screen results
(Clinical history much more important than results of screening)

21
Q

What can cause acquired thrombophilia?

A

Antiphospholipid antibody syndrome

22
Q

Is antiphospholipid antibody syndrome a stronger RF for thrombosis than the hereditary thrombophilias?

A

Yes

23
Q

What are some features of antiphospholipid antibody syndrome?

A

Recurrent thromboses- Arterial, including TIAs, Venous
Recurrent fetal loss
Mild thrombocytopenia

24
Q

What is the pathogenesis of antiphospholipid antibodies?

A

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

25
Q

What are antiphospholipid antibodies?

A

Autoantibodies which have specificity for anionic phospholipids and which prolong phospholipid dependant coagulation tests in vitro
Also known as Lupus anticoagulants

26
Q

What conditions are associated with antiphospholipid antibodies?

A 
AI Disorders
Lymphoproliferative disorders
Viral infections
Drugs
Primary
27
Q

What is the treatment of anti-phospholipid syndrome?

A

Aspirin

Warfarin

Haematology (23 decks)

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