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Haematology > Venous Thrombosis & Anticoagulants > Flashcards

Venous Thrombosis & Anticoagulants Flashcards

1
Q

Describe how veins move blood back to the heart

A

Rely on muscles surrounding to pump the blood
Valves help to move blood towards the heart
Low pressure system - only activates the coagulation cascade

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2
Q

State Virchow’s triad

A

Stasis
Hypercoagulation
Vessel wall

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3
Q

How will a DVT present?

A

Hot, swollen, tender, pitting oedema

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4
Q

How will a PE present?

A

Pulmonary infarction, pleuritic chest pain, collapse, hypoxia, right heart strain

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5
Q

Name the risk factors for venous thrombosis

A 
Age
Obesity 
Pregnancy & Puerperium 
Previous DVT/PE
Trauma/surgery 
Malignancy 
Paralysis 
Oestrogen therapy 
Infection 
Thrombophilia
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6
Q

What is thrombophilia?

A

Inherited condition that increases the chances of having blood clots - increased fibrin clot formation and decreased anticoagulation

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7
Q

What is factor V leiden?

A

Change in factor V meaning it is not switched off as efficiently as normal factor V

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8
Q

Name the types of hereditary thrombophilia

A 
Factor V leiden 
Prothrombin 20210 
Antithrombin deficiency 
Protein C deficiency 
Protein S deficiency
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9
Q

What signs would increase you suspicious of hereditary thrombophilia?

A

Venous thrombosis <45 years old
Recurrent venous thrombosis
Unusual sites
Family history

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10
Q

Describe the management for thrombophilia

A

Short term prophylaxis around events of known risk
Anticoagulation to treat thrombotic event
Long term anticoagulation if recurrent

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11
Q

What signs would suggest long term anticoagulation is required?

A

History of previous thrombosis
Spontaneous thrombosis
Family history
Thrombophilia screening results

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12
Q

What is the main cause of acquired thrombophilia?

A

Antiphospholipid antibody syndrome

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13
Q

State the three main clinical features of anti-phospholipid antibody syndrome

A

Recurrent thrombosis
Recurrent foetal loss
Mild thrombocytopenia

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14
Q

Describe the pathology in anti-phospholipid antibody syndrome

A

Antibodies bind to B2 glycoprotein 1 causing conformation change and activation of primary and secondary haemostasis

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15
Q

What happens to APTT in anti-phospholipid antibody syndrome?

A

Prolong due to artefacts with assay - lupus anticoagulants

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16
Q

What conditions are associated with anti-phospholipid antibody?

A

Autoimmune
Lymphoproliferative
Viral
Drugs

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17
Q

How is anti-phospholipid antibody syndrome managed?

A

Aspirin - arterial

Warfarin - venous

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18
Q

Name the two indications for anticoagulants

A

Venous thrombosis

AF

19
Q

What is the target of anticoagulants?

A

Fibrin clot

Coagulation cascade

20
Q

How does heparin work?

A

Potentiates antithrombin and has an immediate effect

21
Q

How is heparin administered?

A

IV or SC

22
Q

What are the two forms of heparin?

A

Unfractionated

Low molecular weight

23
Q

Describe the mechanism of action of heparin

A

Binds to antithrombin to keep it bound to thrombin/Xa leading to inactivation of coagulation

24
Q

What is the predominant action of the two forms of heparin?

A

Unfractionated - thrombin binding

LMWH - Xa binding

25
Q

How is heparin monitored?

A

APTT is sensitive for unfractionated

Anti-Xa assay can be used for LMWH

26
Q

What are the complications of heparin?

A

Bleeding
Heparin induced thrombocytopenia
Osteoporosis

27
Q

Describe heparin induced thrombocytopenia

A

Antibodies cause platelets to stick together (HITT)

28
Q

Which type of heparin is HITT more common in?

A

Unfractionated

29
Q

How do you reverse heparin?

A

Stop heparin

Protamine sulphate in severe bleeding

30
Q

How does protamine sulphate work?

A

Reverses antithrombin effect and complete reversal for unfractionated and partial for LMWH

31
Q

Name the coumarin anticoagulants

A

Warfarin, phenindione, acenocaoumarin, phenprocoumarin

32
Q

How do coumarin anticoagulants work?

A

Inhibition of vitamin K

33
Q

What depends on vitamin K?

A

Clotting factors II, VII, IX and X

Protein C and S

34
Q

What must be done at the start of warfarin therapy?

A

Heparin should be prescribed as initially increased risk of clot due to protein C and S decreased

35
Q

Describe the action of vitamin K

A

Carboxylation of glutamic acid residues allowing the clotting factors to bind to the platelet

36
Q

Why must warfarin be closely monitored?

A

Narrow therapeutic index

37
Q

How is warfarin monitored?

A

INR - mathematical correction using prothrombin time to allow for differences in lab techniques

38
Q

What is the INR aim for patients on warfarin?

A

2-3

39
Q

How can you reverse warfarin?

A

Stop therapy
Oral vit K if INR >8
Administer clotting factors - blood components

40
Q

How long does vitamin K take to work in comparison to clotting factors?

A

Vit K - 6 hours

Clotting factors - immediate

41
Q

Name the two types of new anticoagulant

A

Oral direct thrombin inhibitor

Oral Xa inhibitor

42
Q

Give an example of an oral direct thrombin inhibitor and what is the problem with it?

A

Dabigatran

Excreted via kidneys and minor insult can lead to complications

43
Q

What are the Xa inhibitors?

A

Edoxaban, rivaroxaban, apixaban

44
Q

What are the indications for the new anticoagulants?

A

Prophylaxis
DVT/PE
Stroke prevention in AF

Haematology (18 decks)

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