Thrombosis and Embolism (haematology) Flashcards

1
Q

What are the three natural anticoagulants we have?

A

Antithrombin
Protein C system
Tissue factor pathway inhibitor (TFPI)

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2
Q

What are the causes of thrombosis?

A

-Stasis
-Vessel wall injury
-Hypercoagulability

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3
Q

What type of clot forms in:
1. Veins
2. Arteries

A
  1. Red clot (rich in fibrin and trapped RBCs.)
  2. White clot (rich in platelets)
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4
Q

What substance is used to treat deep vein clotting?

A

Warfarin

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5
Q

How do we treat the two types of clots?

A
  1. Venous clot- treatment is medication that interrupts with the coagulation cascade, such as warfarin.
  2. Arterial clot- treatment is drugs that block platelet activation.
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6
Q

What are the risk factors for arterial thrombosis? (7)

A

-Elevated factor VIII
-Elevated fibrinogen levels
-Lupus anticoagulant
-Polycythaemia rubra vera
-Essential thrombocythaemia
-Diabetes, hypertension
-Smoking

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7
Q

What are the causes of venous thrombosis? (3)

A

•Thrombophilia (easy formation of blood clots)
•Vessel wall injury (causes plaque formation and plaque rupture)
•Reduced flow (immobility, obesity/pregnancy, limb paralysis, long distance travel).

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8
Q

What are the causes of:
1. Acquired thrombophilia
2. Inherited thrombophilia

A
  1. Pregnancy, contraceptive pill, malignancy, lupus anticoagulant.
  2. Factor V leiden, protein C deficiency, protein S deficiency, prothrombin mutation, antithrombin deficiency.
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9
Q

What are the clinical presentations of thrombosis? (2)

A

Arterial thrombosis- ischaemia (e.g MI)
Venous theombosis- stasis and blockage (e.g deep vein thrombosis)

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10
Q

Treatment for:
1. Arterial thrombosis (5)
2. Venous thrombosis (3)

A
  1. Fibrinolysis, streptokinase, urokinase, TPA as well as antiplatelet therapy.
  2. Warfarin, heparin, and new anticoagulants.
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11
Q

Which coagulation factors does warfarin inhibit?

A

Vitamin K dependent, II, VII, IX and X.

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12
Q

Which coagulation factors does heparin inhibit?

A
  • factor II and X.
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13
Q

What is the mechanism of action for warfarin? (3)

A

Warfarin inhibits the enzyme responsible for the activation of vitamin K.
-Inhibits the activation of vitamin K dependent factors (II, VII, , IX and X) and protein C, S.
-Decreases coagulation.

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14
Q

What are the indications of warfarin:
1. Good evidence
2. Limited evidence

A
  1. Embolic stroke, DVT, atrial fibrillations.
  2. Congestive heart failure, dilated cardiomyopathy, non-embolic stroke, peripheral vascular diseases.
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15
Q

What major risk is associated with using warfarin especially in the elderly?

A

Risk of bleeding

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16
Q

What are the indications of heparin? (5)

A

-Acute venous thrombosis
-Acute artery occlusion
-Pregnancy
-Catheters and lines
-Prophylaxis

17
Q

Side effects of heparin (3)

A

-Bleeding
-Heparin-induced thrombocytopenia
-Osteoporosis

18
Q

Which products are used to reverse warfarin? (3)

A

-Prothrombin concentrate, fresh frozen plasma, vitamin k.

19
Q

Which substance is used to reverse heparin?

A

Protamine sulphate

20
Q

What is the difference between embolism and thrombosis?

A

Thrombosis is easy formation of a blood clot, embolism is when the blood clot travels in the blood vessels (thrombosis can lead to embolism).

21
Q

Risk factors for embolism (5)

A

-Obesity, immobility
-Smoking
-Pregnancy
-Elderly >65
-Diabetes , hypertension

22
Q

Different types of embolism

A

-Cerebro-vascular accident
-Air embolism
-Pulmonary embolism
-Amniotic fluid embolism