Venous thrombosis Flashcards
what is affected in arterial thrombosis
atherosclerosis in high pressured system - affects PLATELETS
what is affected in venous thrombosis
low pressured system affecting COAGULATION (secondary haemostasis)
what drug class is given in arterial thrombosis
antiplatelet (aspirin)
what drug class is given in venous thrombosis
anticoagulants:
acute - heparin
long term - warfarin
what is Virchow’s triad
stasis of blood
vessel wall abnormalities
hypercoaguable state
risk factors for stasis of blood
immobility increased age obesity pregnancy trauma/surgery/previous VTE paralysis malignancy
risk factors for vessel wall abnormalities
increased age
previous VTE
risk factors for hypercoaguable state
age pregnancy/puerperium oestrogen therapy trauma/surgery malignancy infection thrombophilia
presentation of DVT
hot
swollen
tender
pitting oedema
presentation of PE
pleuritic chest pain
worse on breathing
hypoxia
what is thrombophilia
disorders affecting haemostasis to cause thrombosis
what are the hereditary thrombophilias
anti-thrombin III deficiency protein C deficiency protein S deficiency factor V leiden prothrombin 20210 mutation
what does antithrombin III act on
activated clotting factors - VIIa, IIa, Xa, VIIIa and IXa
what do proteins C and S work on
factors V and VIII
what is factor V leiden
single base change in factor V
protein C and S cant switch it off
when should someone be screened for hereditary thrombophilia
VTE <45 years
recurrent VTEs
VTEs in unusual places
family history of VTEs or thrombophilia
management of patients with inherited thrombophilia
avoiding risks (eg oestrogen and HRT, weight loss etc) short term prophylaxis in times of higher risk (surgery, pregnancy) long term anticoagulation if recurrent
what is antiphospholipid syndrome
connective tissue disease
pathophysiology of antiphospholipid syndrome
anticardiolipin antibodies cause a conformational change in B2 glycoprotein1
activates primary and secondary haemostasis and causes vessel wall abnormalities (acts on phospholipids)
how does antiphospholipid syndrome present
recurrent arterial AND venous thrombosis
recurrent foetal loss
mild thrombocytopenia
management of antiphospholipid syndrome
antiplatelet AND anticoagulation
