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DEN303 - IHD > Clinical Aspects of Thrombosis > Flashcards

Clinical Aspects of Thrombosis Flashcards

1
Q

Definition of thrombosis

A

Blood in blood vessel should be fluid

Inappropriate blood coagulation within a vessel

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2
Q

How does appropriate blood coagulation occur?

A

When blood escapes from a vessel (failure of this results in bleeding)

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3
Q

Types of thrombosis (x2)
What kind of pressure system?
Rich in?
Treatment therefore?

A 
In the arterial circulation 
High pressure system
Platelet rich - anti platelet 
In the venous circulation
Low pressure system 
Fibrin rich - anticoagulants
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4
Q

Clinical thrombosis - two types and examples

A 
Arterial thrombosis 
Myocardial infarction 
Thrombotic stroke
Venous thrombosis
Leg deep vein thrombosis (MI) 
Pulmonary embolism (PE)
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5
Q

Thrombosis treatment
AT
VT

A

Anti platelet drugs

Anticoagulant drugs

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6
Q

Atherosclerotic plaque formation process

A
  • Initial fatty streak
  • Plaque enlargement
  • Turbulence due to protrusion into lumen and RUPTURE
  • Loss of endothelium and adherence to wall
  • Fibrin meshwork deposition and red cell entrapment
  • More turbulence, more platelet and fibrin deposition
  • Thrombus of layers of platelets, fibrin and red cells
  • CLOT FORMED
  • any structure distal to artery will die
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7
Q

Risk factors for arterial thrombosis
Main
Other

A
  • Family history
  • Diabetes mellitus
  • Hypertension
  • Hyperlipidaemia
  • Smoking
  • Atrial fibrillation for stroke
  • Male sex
  • Polycythaemia, gout
  • Collagen vascular disease
  • Lupus anticoagulant, high FVIII, high fibrinogen
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8
Q

Arterial thrombosis - management and examples

A

Lifestyle - quit smoking, exercise, diet and weight control

Antithrombotics: primary prevention in patients with atrial fibrillation

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9
Q

Arterial thrombosis treatment options

A

Anti platelet agents

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10
Q

AT Treatment options - antiplatelet agents

2x

A

Aspirin:
Irreversible inhibitor of cyclooxygenase (COX1)
Inhibition of production thromboxane
Inhibition lasts platelet lifetime
Risk reduction of non-fatal vascular event by 30%
Risk reduction of fatal vascular event by 15%
Effect will last for a week after stopping it

Clopidogrel
Irreversible ADP mediated platelet inhibition
Inhibition lasts for lifespan
18% decrease in risk of MI
Risk of coronary stent thrombosis/recurrent stroke by 30%

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11
Q

Arterial thrombosis – Treatment options Thrombolysis

Indications and drugs involved and side effect

A

MI
Stroke within 3 hrs
life threatening PE

Alteplase
Streptokinase
others
Bleeding

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12
Q

Arterial thrombosis – Treatment options - Invasive

A

Percutaneous coronary intervention - cardiac stenting - use stent to keep passage open
- combined with 3-12 months aspirin + clopidogrel
Coronary artery bypass grafting
Carotid endarterectomy - inject dye to see where blockage is

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13
Q

Arterial thrombosis – Treatment options - REHABILITATION of stroke survivors

A

Stroke - swallowing, malnutrition, mobilisation

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14
Q

Arterial thrombosis – Treatment options - secondary prevention

A

Lifestyle

  • exercise, smoking cessation, weight control, safe alcohol use
  • blood pressure control
  • cholesterol lowering
  • diabetic control
  • antithrombotic therapy in stroke associated with atrial fibrillation
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15
Q

Atrial fibrillation - characteristics

A 
Irregularly irregular heart rhythm 
8% > 80 y/os 
Left atrial thrombus due to stasis of blood in atrium --> clot
Embolisation leads to stroke if occurs
Impaired cardiac output
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16
Q

AF treatment

A

DC cardioversion
Heart rate control
Anticoagulation

17
Q

Heart rate control methods

A 
Beta blockers,
Ca channel blocker
Digoxin 
AV junction ablation 
Anticoagulation
18
Q

How does AF cause stroke

A

Blood pools in atria
Blood clot forms due to stasis
Blood clot breaks off
Blood clot travels to brain and blocks a cerebral artery causing stroke

19
Q

How is it detected in ECG?

A

Abnormal electric pathways between nodes results in multiple triggers of contraction leading to irregular pattern on ECG

20
Q

Venous thrombosis

Most begins as?

A

Low pressure system
Fibrin rich
Treated with anticoagulants
Deep vein thrombosis in the leg

21
Q

DVT –> ??

A

Downwards to leg ulcers

22
Q

DVT –> upwards

A

PE

23
Q

Formation of venous thrombosis - virchow

A

Clotting factors - hypercoagulability
Vessel wall damage
Flow –> stasis

24
Q

Risk factors for venous thrombosis - 3 types

Definition in terms of risk

A

VTE is a multifactorial disorder occurring through the interplay of one or more genetic and/or environmental risk factors when a critical thrombotic threshold is reached.

Heritable e.g factor V leiden
Acquired
Mixed

25
Q

Heritable thrombophilias

Associated with?

A

Associated with idiopathic VTE at young age
Incidence is 1/10000
Higher with older age
Common in hospitalised (150x) and immobilised patients

26
Q

VTE - prevention

A

Risk assessment
Thromboprophylaxis
Adequate hydration
Early mobilisation

27
Q

VTE - prevention
Prophylaxis
Mechanical
Chemical

A

Mechanical

  • all surgical patients at risk of ate
  • graduated elastic compression hosiery
  • intermittent pneumatic compression

Chemical - prevents 50-70%
Low molecular weight heparin
Direct oral anticoagulants

28
Q

VTE - treatment options Acute

A

Anticoagulation
Thrombolysis
Thrombectomy
Inferior vena cava filter to catch clots

29
Q

VTE - treatment options Long-term

A

Anticoagulation

Stockings

30
Q

Treatment of VTE - duration

A

3 months of anticoagulants after first event
Provoked events do not need anticoagulation for >3months
Distal DVT does not need anticoagulatory treatment for > 3months
Consider long term anticoagulation after 1st unprovoked thrombosis

31
Q

Venous Thrombosis - summary

A

Multifactorial disease

Associated with significant mortality/morbidity

Prevention essential, especially in hospital setting

Treatment mainly with anticoagulants
Optimum duration debated
Associated with increased risk of bleeding

32
Q

Arterial Thrombosis - summary

A

Both venous and arterial thrombosis have high morbidity and mortality.
Prevention is essential in both

Treatment is with systemic anticoagulation in venous thrombosis and antiplatelet agents in arterial thrombosis

DEN303 - IHD (58 decks)

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