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2a- Cardiology > Venous thrombosis and anti-thrombotic therapy > Flashcards

Venous thrombosis and anti-thrombotic therapy Flashcards

1
Q

What is thrombosis?

A

Solid mass of blood constituents formed within intact vascular system during life

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2
Q

What are the conditions that allow thrombosis in arterial circulation?

A

high pressure + platelet rich

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3
Q

What are the conditions that allow thrombosis in venous circulation?

A

low pressure + fibrin rich

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4
Q

Where are the 3 main locations for arterial thrombosis?

A

Coronary circulation
Cerebral circulation
Peripheral circulation

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5
Q

What occurs after an arterial thrombosis in the coronary circulation?

A

Pain in left arm, angina, myocardial infarction, sudden death

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6
Q

What occurs after an arterial thrombosis in the cerebral circulation?

A

Slurred speech, headaches, stroke

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7
Q

What occurs after an arterial thrombosis in the peripheral circulation?

A

Pain in leg, gangrene, peripheral vascular disease

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8
Q

What is an example of another territory arterial thrombosis can occur in?

A

Superior mesenteric artery (SMA)

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9
Q

What does an arterial thrombosis in the SMA lead to?

A

Abdominal pain

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10
Q

What is the normal bleeding time?

A

2-9 minutes

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11
Q

What are the causes of arterial thrombosis?

A
  • Atherosclerosis
  • Inflammatory
  • Infective
  • Trauma
  • Tumours
  • Unknown
    • Platelet driven
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12
Q

What is the underlying cause of arterial thrombosis in majority of cases?

A

Atherosclerosis

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13
Q

What are risk factors for atherosclerosis?

A

Smoking
Hypertension
Diabetes
Hyperlipidaemia
Obesity/ sedentary lifestyle
Stress/ type A personality

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14
Q

What are the 3 main presentations of arterial thrombosis?

A
  • Myocardial infarction (MI)
  • CVA
  • Peripheral vascular disease
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15
Q

What is CVA?

A

cerebrovascular accident eg. stroke

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16
Q

How can you diagnose MI?

A
  • History
  • ECG
  • Cardiac enzymes
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17
Q

How can you diagnose CVA?

A
  • History and examination
  • CT scan/ MRI
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18
Q

How can you diagnose peripheral vascular disease?

A
  • History and examination
  • Ultrasound
  • Angiogram
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19
Q

What are the treatments for MI?

A

Aspirin – inhibits platelet function
LMWH
Thrombolytic therapy

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20
Q

What are the treatments for stroke?

A

Aspirin or clopidogrel, tiglacor; anti-platelet
TPA (tissue plasminogen activator) – generates plasmin, degrades fibrin
Treat risk factors

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21
Q

What is LMWH?

A

Low molecular weight heparin

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22
Q

Why is Fondaparinux used instead of heparin?

A
  • Much higher risk of bleeding with heparin
  • Longer half life with fondaparinux
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23
Q

What is DVT?

A

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg

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24
Q

What are the most common DVT signs?

A

Calf pain, chest pain, breathlessness

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25
What type of signs and symptoms are seen in DVT?
Non-specific
26
What are causes of venous thrombosis that affect blood flow?
- Immobilisation - Surgery - Trauma
27
What are causes of venous thrombosis that cause damage to the vessel wall?
Injury - chemical, physical
28
What are some genetic causes of venous thrombosis?
- Factor V Leiden - Antithrombin deficiency
29
What are some acquired causes of venous thrombosis?
- Anti-phospholipid syndrome - Lupus anticoagulant
30
What part of Virchow's triad do genetic and acquired causes affect?
Blood constituents
31
What are the basic symptoms of DVT?
Pain, swelling
32
What are the basic signs of DVT?
tenderness, swelling, warmth, decolourisation
33
What are risk factors for DVT?
- Surgery, immobility, leg fracture, POP - OC pill, HRT, pregnancy - Long haul flights - Inherited thrombophilia – genetic predisposition (Caucasian)
34
What investigation can be done for DVT?
D-dimer Positive result
35
What else can a positive D-dimer test show?
surgery/ pregnancy/ infection Does not confirm diagnosis of DVT
36
What imaging can be done for DVT?
- Ultrasound compression test proximal veins - Venogram by CT or MRI for calf (bigger), recurrence, uncertain
37
How can you mechanically prevent DVT?
hydration and early mobilisation, compression stockings, foot pumps
38
How can you chemically prevent DVT?
LMWH
39
What is the treatment for DVT?
- Oral warfarin - LMWH - DOAC (direct oral anticoagulant) - Compression stockings - Treat underlying cause – malignancy, thrombophilia
40
What is the endo-vascular form of treatment for DVT?
- Catheter inserted into vein - Clot either blasted by jet, sucked away etc
41
What is thromboprophylaxis?
the prevention of clots forming in the veins
42
What is a PE?
Pulmonary embolism
43
What is a pulmonary embolism?
A blockage in one of the pulmonary arteries in your lungs, often caused by blood clots that travel to the lungs from the legs (DVTs)
44
What are symptoms of a PE?
- breathlessness - pleuritic chest pain - symptoms of DVT - risk factors for DVT - Cyanosis
45
What are signs of a PE?
- tachycardia - tachypnoea - pleural rub, - Signs of DVT
46
What is the common presentation of PE?
Differential diagnosis of chest pain and SOB
47
What is the differential diagnosis of PE?
Musculoskeletal, Infection, Malignancy, Pneumothorax, Cardiac, GI causes
48
What do initial investigations for PE usually show?
- CXR usually normal - ECG sinus tachy - Blood gases: type 1 resp failure, decreased O2 and CO2
49
What are further investigations for PE?
- D-dimer: normal excludes diagnosis - Ventilation/ Perfusion scan: mismatch defects
50
What is treatment for PE?
- LMW heparin - DOAC - Oral warfarin - Treat the cause
51
How can you prevent PE?
- Anticoagulation - IVC (inferior vena cava) filters if anti-coagulating doesn't work - Life saving intervention
52
What are mechanical ways to prevent PE?
Similar to prevention for DVT - Early mobilisation and hydration - Mechanical mobilisation – foot pumps
53
What are chemical ways to prevent PE?
LMWH
54
What are features of a massive PE?
- Haemodynamic instability - Rare
55
What can the consequences of a massive PE be?
Hypotension, cyanosis, severe dyspnoea, right heart strain/ failure
56
What could you consider for a massive PE?
embolectomy
57
What is bridging?
unstable medication such as warfarin → stable medication such as LMWH while in-patient → back to unstable warfarin
58
What are features of heparin?
- Given IV, need canula - Given by continuous infusion - Continuous monitoring - Glycoaminoglycan - Binds to antithrombin and increases its activity - Indirect thrombin inhibitor - Short half life - If you stop it, action wears off quickly
59
What are features of LMWH?
- Smaller molecule, less variation in dose and renally excreted - Once daily, weight-adjusted dose given subcutaneously - Subcutaneous usually in stomach - Used for treatment and prophylaxsis
60
What are features of warfarin?
- Orally active - Prevents synthesis of active factors II, VII, IX and X - Antagonist of vitamin K - Long half life (36 hours) - Prolongs the prothrombin time - Difficult to use - Individual variation in dose - Need to monitor
61
What are features of DOACs?
- Orally active - Directly acting on factor II or X - No blood tests or monitoring - Shorter half lives so bd or od - Used for extended thromboprophylasis and treatment of AF and DVT/PE - Not used in pregnancy - Measure anti 10a levels to see function
62
What are features of aspirin?
- Inhibits cyclo-oxygenase irreversibly - Act for lifetime of platelet, 7-10 days - Inhibits thromboxane formation and hence platelet aggregation - Used in arterial thrombosis, 75-300 mg od

2a- Cardiology (7 decks)

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