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Clinical Pathology > Thrombosis and Risk factors for thrombosis > Flashcards

Thrombosis and Risk factors for thrombosis Flashcards

1
Q

What are the 3 factors that contribute to increased risk of thrombosis (Virchow’s triad)?

A
  • Change in blood flow (stasis)
  • Change in blood composition (hyper coagulation)
  • Damage to vascular endothelium
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2
Q

What is the primary pathological reason for arterial thrombosis?

A

Atherosclerotic plaque formation and rupture

  • platelet aggregation and thrombi formation
  • increased with obesity, hypertension, smoking, diabetes, family history, inactivity, male,, age
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3
Q

What are the main causes for venous thrombi?

A

Stasis - lack of flow due to venous damage/compression

Hyper coagulability - thrombi composed of FIBRIN rather than platelet aggregation/accumulation

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4
Q

How does venous thrombi present?

A

DVT - swelling, warm, painful to touch

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5
Q

What is the main complication of DVT?

A

Pulmonary embolism

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6
Q

What are the clinical presentations of PE?

A

Syncope
AF (new)
Cough - haemoptysis

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7
Q

What are the complications of venous thromboembolism?

A
  • Sudden death

- Post thrombotic syndrome - chronic leg swelling, discomfort, ulceration

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8
Q

What is the definition of hospital acquired venous thromboembolism?

A

VTE within 90 days of discharge

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9
Q

What does the care pathway for venous thromboembolism comprise?

A

1 Assess risk for VTE

2 Assess bleeding risk (due to anti coagulant drugs being view)

3 VTE prophylaxis (mechanical/pharmaceutical depending on bleeding risk)

4 Assess risks

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10
Q

What are the risk factors for VTE?

A
  • Cancer/treatment
  • > 60yrs old
  • Trauma/surgery
  • Dehydration
  • Thrombophilias (blood conditions)
  • Comorbilities e.g. MI
  • Immobility
  • HRT/oestrogen
  • History of VTE
  • Family history of VTE
  • Pregnancy
  • Obesity (>30 BMI)
  • Varicose veins
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11
Q

What comprise the pro-coagulant and anti-coagulant factors?

A

Procoagulant - platelets and clotting factors

Anticoagulant - protein C/S, AT-III, fibrinolytic system

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12
Q

What is the general advice for people at risk of VTE?

A

_ensure they are well hydrated

  • ensure they are mobile asap
  • Aspirin/other antiplatelts = not adequate prophylaxis
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13
Q

Name a mechanical form of VTE prophylaxis?

A

Compression stockings (increasing compression as you go down leg)

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14
Q

What are the pharmacological VTE prophylaxis?

A

Low dose low molecular weight heparin

Dabigatran - thrombin inhibitor

Apixaban - factor X inhibitor

Fondaparinox - antiXa inhibitor

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15
Q

How does heparin induce its effects?

A

Activates Antithrombin or inhibits Xa (different ways)

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16
Q

What does fractionated heparin do?

A

Blocks Xa and binds to antithrombin (stimulates) in equal amounts

17
Q

What does low molecular weight heparin do?

A

Binds to both anti Xa and antithrombin but confers more an anti Xa effect

18
Q

Whats does fondapprinux do?

A

Only binds to anti Xa activity

19
Q

What does dabigatran/ apixaban do?

A

Bind factor X and thrombin directly

20
Q

What are D-dimers? What are they used for?

A

Products of fibrin breakdown by plasmin

Elevated D-dimers = fibrin clots have formed and plasmin has broken then down - therefore, exclusion

21
Q

What exclusion tests for PE/DVT are performed?

A

Wells score

22
Q

What is a useful way to diagnose DVT

A

CT scan/Ultrasound

23
Q

What is the treatment for DVT/PE?

A

Low molecular weight heparin then warfarin (overlap)

  • Dabigatran (inhibits thrombin)
  • apixaban (inhibits factor X)
  • Fondaparinux (anti Xa)
24
Q

Whats is the management for VTE (recurrent)?

A

Warfarin

If because of pregnancy, only temporary so do not consider warfarin

25
Q

What is a thrombopilia?

A

Acquired/congenital condition of haemostasis mechanism that predisposes individual to thrombosis

26
Q

Name some INHERITED thrombophilia conditions

A

Protein C/S deficiency

Anti thrombin deficiency

Factor V Leiden

Prothrombin 20210A

27
Q

Name an ACQUIRED thrombophilia condition

A

Antiphospholipid

28
Q

What are the clinical features of thrombophilias?

A
  • DVT
  • PE
  • Thrombosis in axillary, portal, cerebral and mesenteric veins
29
Q

What is the function of antithrombin?

A

Xa and thrombin inhibitor

30
Q

What is the function of protein C? how is it activated?

A

Thrombin binding to thrombomodulin on endothelium

  • complex activates protein C
  • anticoagulant (balances coagulant-anticoagulation)
31
Q

What is the function of protein S?

A

Cofactor of protein C -functions to break down factors 5 and 8 by proteolysis

32
Q

How is protein C/S deficiencies inherited?

A

Autosomal dominant (50% chance of inheriting in parent = sufferer)

33
Q

What is factor V leiden?

A

Factor V resistance to protein C cleavage

34
Q

What does prothrombin 20210A do?

A

Point mutation

Increases prothrombin levels

Clinical Pathology (50 decks)

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