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Cardiorespiratory CC > Venous Thromboembolism > Flashcards

Venous Thromboembolism Flashcards

1
Q

Thrombosis

A

Pathological formation of a blood clot within a vessel

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2
Q

Embolism

A

Rupture of clot from vessel wall

Travels through circulation until obstructed by smaller vessel

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3
Q

Venous thrombi

A

Red clots

RBCs within a fibrin mesh

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4
Q

Arterial thrombi

A

White clots

Platelets and fibrin

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5
Q

Majority of DVT originate in

A

Calf venous sinuses

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6
Q

Pulmonary embolism

A

3rd most common cause of CV death

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7
Q

Virchow’s Triad- VTE cause

A

Reduced blood flow (stasis)
Vessel wall disorder
Hypercoagulability

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8
Q

VTE epidemiology

A

Hereditary 25%
Acquired 50%
Idiopathic 40%
Caused by antithrombin, protein C + S deficiency

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9
Q

Strong Risk Factors VTE

A 
Fracture hip
Major trauma
Hip/knee replacement
Spinal cord injury
Major surgery
Hospitalisation with acute medical illness
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10
Q

Moderate Risk Factors VTE

A 
Previous VTE
Cancer
Resp. Failure
Thrombophilia
Pregnancy
Combined pill/HRT
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11
Q

Weak Risk Factors VTE

A 
Bed rest > 3 days
Travel
Obesity
Varicose veins
Day-case surgery
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12
Q

DVT Presentation

A

Unilateral

Pain, swelling, tenderness

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13
Q

Objective diagnosis DVT

A

Clinical pre-test probability- Well’s score
D-dimer
Radiological assessment

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14
Q

Well’s score DVT

A 
Active cancer within last 6 months
Recent immobilisation
Recently bedridden
Localised tenderness near deep veins
Entire leg swollen
Pitting oedema
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15
Q

D-dimer DVT

A

Blood test

Tests for non-specific marker of fibrin formation

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16
Q

Radiological assessment DVT

A

Usually compression ultrasound
Sometimes venography
CT scan

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17
Q

DVT Complications

A

Pulmonary embolism
Recurrent VTE
Post-thrombotic syndrome

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18
Q

Post-thrombotic syndrome

A

Recurrent pain + swelling in leg due to venous hypertension
Due to obstruction + valve damage
30-50% of proximal DVT

19
Q

Pulmonary Embolism presentation

A

Pulmonary infarction
Breathlessness
Collapse, shock

20
Q

PE signs + symptoms

A 
Breathlessness
Collapse
Tachycardia
Crepitations 
Raised JVP 
Pleural effusion
21
Q

PE Diagnosis

A

Non-diagnostic –> may or may not be present

22
Q

PE Arterial gases

A

Hypoxia
Low CO2
often normal

23
Q

Hampton’s Hump

A

Peripheral wedge shaped opacity representing pulmonary infarction + atelectasis secondary to a pulmonary embolus

24
Q

PE Diagnostic tests

A 
CT Pulmonary Angiogram
Isotope Lung
Echocardiogram
Pulmonary angiogram
D-dimer
Leg ultrasound
25
Q

DVT, VTE + PE treatment

A

Start heparin if likely
Once confirmed, continue heparin with warfarin
Stop heparin after minimum 5 days (INR in normal range for 2 days)
Continue warfarin

26
Q

Low molecular weight heparin

A 
Mainly VTE treatment
Safer than unfractioned
Half life 4 hours
Anti-Xa
Anti-thrombin
Subcutaenous
27
Q

Un-fractioned Heparin

A

90 min half life
Used when rapid reversibility required
IV or subcutaenous

28
Q

Heparin side effects

A

Major bleeding
Heparin induced thrombocytopenia- low platelets
Osteoporosis

29
Q

Specific heparin antagonist

A

Protamine sulphate

30
Q

Fondaparinux

A

18 hours half life
Synthetic pentasaccharide
Unsuitable if renal impairment

31
Q

Warfarin

A 
Vitamin K antagonist
Oral
36 hour hald life
Primarily affects INR
Teratogenous
Major bleeding risk
Reduces risk of recurrence during treatment by 90%
32
Q

DOACs

A

Dabigatran

Rivaroxaban

33
Q

Dabigatran

A

DOA

Acts on thrombin

34
Q

Rivaroxaban

A

DOA

Acts on factor Xa

35
Q

Pregnancy VTE

A

Use LMWH

36
Q

Breast feeding VTE

A

LMWH and warfarin safe

NOT DOACS

37
Q

Cancer VTE

A

LMWH

38
Q

VTE recurrence

A

Risk after stopping anticoagulants
5% risk year 1
30% risk by 10 years

39
Q

Thrombolysis

A

“clot-busting” therapy

Massive PE or life threatening DVT

40
Q

Inferior vena cava filter

A

If major contra-indication to anticoagulation

41
Q

Thrombophilia

A

laboratory detected predisposition to thrombosis

42
Q

Thrombophilia heritable causes

A 
Factor V Leiden
Prothrombin gene mutation
Protein C deficiency
Protein S deficiency
Antithrombin deficiency
43
Q

Antiphospholipid Syndrome (APS)

A

Acquired form thrombophilia
Primary
Secondary to connective tissue disorder e.g. SLE

44
Q

APS Diagnostic criteria

A

Thrombosis
Pregnancy morbidity
Lab criteria

Cardiorespiratory CC (34 decks)

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