4: Venous thrombosis

Question 1

.Thrombosis can be either ___ or ___.

Answer 1

arterial or venous

Question 2

What is a common type of venous thrombosis?

What lethal consequence can it have?

Answer 2

DVT

Pulmonary embolism

Question 3

Where do DVTs occur?

Why?

Answer 3

Lower limbs

Virchow’s triad

Question 4

What is the pathophysiology of arterial thrombosis?

Answer 4

Atherosclerotic disease

with a background of hypertension, hyperlipidaemia, diabetes….

Question 5

What are some presentations of arterial thrombosis?

Answer 5

Angina

Intermittent claudication

Stroke

Question 6

Which blood components are involved in arterial thrombosis?

Answer 6

Platelets

so prevent with anti-platelets

Question 7

Apart from starting anti-platelet drugs, what can a patient do to reduce their risk of arterial thrombosis?

Answer 7

Modify risk factors through lifestyle

Question 8

Are platelets involved in arterial thrombosis?

Answer 8

Yes

Question 9

Are platelets involved in venous thrombosis?

Answer 9

No

Fibrin - treat with anti coagulants

Question 10

Which anti-coagulant drugs are used to treat venous thrombosis?

Answer 10

Warfarin

Heparin

NOACs

Question 11

What is Virchow’s triad of venous thrombosis?

Answer 11

Endothelial damage

Hypercoagulability

Stasis

Question 12

What is meant by hypercoagulability?

Answer 12

Increased tendency to clot

Blood disorders e.g thrombophilia, polycythaemia

Acute inflammation (clotting factors are acute phase proteins)

Pregnancy (physiological increase in clotting factors)

Question 13

Which traditional anti-coagulants are used

a) acutely
b) chronically?

Answer 13

a) Heparin

b) Warfarin

Question 14

What are the classic symptoms of a DVT?

Answer 14

Warm, swollen, oedematous, painful lower limb

Usually asymmetrical

Question 15

What are the symptoms of a PE?

Answer 15

Pleuritic chest pain

SOB

Haemoptysis

Question 16

What are the characteristic ECG findings in PE?

Answer 16

S1 Q3 T3

Question 17

What are some risk factors for VTE?

Answer 17

Increasing age

CVD risk factors

Pregnancy

Hormonal trherapy

Trauma, malignancy, infection, thrombophilia…

i.e VITAMINS ABCDEK

Question 18

In which states do clotting factor levels increase?

Answer 18

Obesity

Pregnancy

Hormonal contraception

Infection

Malignancy…

i.e all of them again

Question 19

Which inherited blood disorder greatly increases your chances of developing VTE?

Answer 19

Thrombophilia

Question 20

Which protein switches off thrombin and acts as a natural anticoagulant?

Answer 20

Antithrombin

Question 21

Apart from antithrombin, which other naturally occuring proteins act as anticoagulants?

Answer 21

Protein C and Protein S

Thrombin (with thrombomodulin)

Question 22

Which protein, affected by a common gene mutation, inhibits the activity of Protein C and S?

Answer 22

Factor V Leiden

Question 23

What is the risk of VTE in a patient with a Factor V Leiden mutation compared to the general population?

Answer 23

5x population average

Question 24

Which anticoagulant proteins are affected by mutations causing thrombophilia?

Answer 24

Antithrombin

Protein C and S

Factor V

Question 25

In **which groups of patients** would you consider screening for **inherited thrombophilias?**

Answer 25

**People with VTE aged \< 40** **People with recurrent VTEs** **People with VTEs in weird places** **People with family histories of thrombophilia**

Question 26

The period after ___ is highest risk for VTE.

Answer 26

**period after pregnancy** i.e the peurperium

Question 27

Which form of **contraception** increases a woman's risk of VTE by 7 times?

Answer 27

**OCP**

Question 28

Risk factors for VTE tend to \_\_\_.

Answer 28

**accumulate** e.g age, immobility, OCP, Factor V Leiden, Fx, Hx over time... **multiplying risk**

Question 29

What is the risk of **using anticoagulation** to **prevent or treat VTE**?

Answer 29

**Abnormal bleeding** other end of the spectrum

Question 30

Which **autoimmune condition** causes **acquired thrombophilia?**

Answer 30

**Anti-phospholipid syndrome**

Question 31

What condition is **APS** associated with?

Answer 31

**Systemic lupus erythematosus** **(SLE)** Another autoimmune disease

Question 32

What occurs in **aPS?**

Answer 32

**Recurrent arterial and venous thrombosis** **Recurrent miscarriage**

Question 33

What is given to pregnant women with **known aPS?**

Answer 33

**Prophylactic heparin** (anti-coag) and **aspirin** (anti-platelet)

Question 34

What are the three important **anti-phospholipid antibodies**?

Answer 34

**Anti-B2 glycoprotein** **Anti cardiolipin** **Anti lupus anticoagulant**

Question 35

Which **clotting time** is prolonged in **antiphospholipid syndrome?**

Answer 35

**APTT**

Question 36

Which **autoimmune disease** is associated with **aPS?**

Answer 36

**SLE**

Question 37

How is **aPS** treated?

Answer 37

**Anti-platelet** - aspirin **Anti-coagulant** - warfarin life long modify CVD risk factors