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Haematology > Venous Thrombosis > Flashcards

Venous Thrombosis Flashcards

1
Q

What will an arterial thrombotic event lead to?

A

MI
Stroke
Peripheral - critical limb ischaemia

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2
Q

What will a venous thrombosis lead to?

A

DVT

PE

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3
Q

Describe an arterial thrombus?

A

Due to high pressure system and formation of atherosclerotic plaque
Plaque rupture leads to platelet aggregation and soft plug forming
PRIMARY HAEMOSTASIS
Platelet rich thrombus

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4
Q

How is an arterial thrombus treated?

A

Aspirin
Clopidogrel
Modify risk factors for atherosclerosis

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5
Q

Describe a venous thrombosis?

A

Low pressure system
Platelets NOT activated
SECONDARY HAEMOSTASIS
Fibrin rich clot

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6
Q

What is the treatment for a venous thrombosis?

A

Warfarin
Heparin
DOACs

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7
Q

What is virchow’s triad?

A

Stasis
Vessel wall abnormality
Hypercoagulability

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8
Q

What is the single biggest risk factor for a venous clot?

A

A previous clot

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9
Q

Describe a DVT affected leg

A

Hot
Swollen tender
Pitting oedema
DDx; cellulitis

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10
Q

Describe a PE

A 
Pleuritic chest pain 
CV collapse 
Death
Hypoxia
Right heart strain 
ECG; right axis deviation (negative lead 1, positive aVF), tachycardic 
Rarely; S1Q3T3
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11
Q

What is the risk of VTE?

A

1/1000 per annum
Young adults; 1/10,000 per annum
Elderly 1/100 per annum
Lifetime risk is 2.5%

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12
Q

What are risk factors for increased stasis in VTE risk?

A 
Age
Marked obesity
Pregnancy
Previous DVT/PE 
Trauma/ surgery 
Malignancy
Paralysis
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13
Q

What are risk factors for VTE that fall under vessel wall?

A

Age; decreased collagen

Previous DVT/ PE; damage to valves

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14
Q

What are the risk factors fro VTE that fall under hypercoaguability?

A 
Age
Pregnancy
Puerperium
Oestrogen therapy 
Trauma/ surgery 
Malignancy
Infection 
Thrombophilia
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15
Q

Why are the hypercoagulable states associated with increased risk of VTE?

A

Release of tissue factor
Increased VWF
Increased factor 8

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16
Q

What is a thrombophilia?

A

Familial or acquired disorder of haemostatic mechanism which is likely to predispose to thrombosis

17
Q

What are the mechanisms of thrombophilia?

A

Increased coagulation activity; platelet plug formation, fibrin clot formation
Decreased fibrinolytic activity
Decreased anticoag activity

18
Q

What is the most common mechanism for thrombophilia?

A

Decreased anticoag activity

19
Q

What will anti-thrombin act on?

A

TF/ factor 7a
5/10a
8/9a
Thrombin

20
Q

Can you have a deficiency in anti-thrombin?

A

Yes

21
Q

What is factor 5 leiden diseaes?

A

COMMONEST thrombophilia

Change in factor 5 that means protein C and S can’t turn it off

22
Q

What are the different types of hereditary thrombophilias?

A 
Factor 5 leiden - 5 fold increase
Prothrombin 20210 mutation - 2 fold increase 
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
23
Q

In what cohort of people 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
24
Q

What is the management of a hereditary thrombophilia?

A

Avoidance of risk
Short term prophylaxis at time of high risk e.g. planned surgery
Short term anticoagulation to treat thrombotic events
Long term anticoag for RECURRENT thrombotic events

25
Q

How can the risk of recurrent thrombosis be assessed?

A

Clinical history much more important than results of thrombophilia screening
History of previous thrombosis
Spontaneous thrombosis rather that acquired transient risk factor
Family history
Thrombophilia screen results

26
Q

What is the commonest acquired thrombophilia?

A

Antiphospholipid antibody syndrome

27
Q

What are the features of APS?

A

Recurrent arterial AND venous thrombosis
Recurrent foetal loss
Mild thrombocytopenia

28
Q

What is the pathogenesis of APS?

A

Abs lead to conformational change in beta-2 glycoprotein 1 which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities

29
Q

What will APS do to the screening fibrin clot tests?

A 
Increased APTT (same result as heparin) 
Lupus anticoagulant interferes with assay prolonging APTT even though they are prone to clots and therefore would expect a short APTT
30
Q

What will prolong the APTT?

A

Haemophilia
Heparin treatment
APS
Mixed factor abnormalities

31
Q

What are conditions associated with antiphospholipid antibodies?

A 
Autoimmune disorders
Lymphoproliferative disorders
Viral infections; EBV
Drugs
Primary APS
32
Q

What is the treatment of APS?

A

Activation of both primary (arterial) and secondary (venous) haemostasis
Need to treat the problem they have; arterial clots = aspirin, venous clots = warfarin

33
Q

Why is warfarin particularly good in APS?

A

Has action on venous and arterial system

APS is the only condition where warfarin is indicated in place of DOACs

Haematology (31 decks)

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