44 - Thrombosis and Risk factors for Thrombosis Flashcards
Arterial thrombosis
Atherosclerosis of vessel wall is usually primary pathological abnormality
Rupture of atheromatous plaques causing endothelial injury
Arterial thrombosis - risk factors
Smoking Hypertension Hypercholesterolaemia Anaemia Family history Obesity Physical inactivity Age Male
Venous thrombosis - pathogenesis
Venous stasis
Hypercoagulable state
Venous thrombosis - thrombus type
Fibrin with a lesser role for platelet accumulation and aggregation
Arterial thrombosis - thrombus type
Platelet aggregation and platelet thrombi play an important role in vessel occlusion
VTE - incidence
1 per 1,000 pa
VTE - prophylaxis
Consistent risk assessment
Appropriate prophylaxis
VTE - treatment
Prompt diagnosis
Guideline led unified care
VTE - risk factors
Active cancer + cancer treatment 60+ Critical care admission Dehydration Known thrombophilias One or more medical comorbidities Surgery Major trauma Personal history of VTE HRT Oestrogen-containing contraceptive therapy Varicose veins with phlebitis Obesity Pregnancy/post-natal period Immobility First degree relative with VTE
Procoaglant - chemicals
Platelets
Clotting factors
Anti-coagulant - chemicals
Protein C
Protein S
Anti-thrombin III
Fibrinolytic system
Pharmacological prophylaxis
Low dose low molecular weight heparin
Fondaparinux
Direct inhibitors of Factor Xa - rivaroxaban
Direct thrombin inhibitors - dabigatran
LMWH treatment
Fixed by body weight
Once daily by subcut
Treat for at least 5 days
Overlap with warfarin until INR >2.0 for two days
How much does warfarin dose vary? how does this compare to novel treatment for VTE?
Varies 40 fold
vs no need for routine monitoring and standard for each specific population
Thrombophilia definition
Familial or acquired disorder of haemostatic mechanism which are likely to predispose to thrombosis.
