Clinical Aspect Thrombosis

Question 1

What is thrombosis?

Answer 1

Inappropriate coagulation in vessel (appropriate coagulation when blood escapes vessel)

Question 2

2 types of thrombosis?

Answer 2

Arterial thrombosis: high pressure, platelet rich –> lead MI, stroke
Venous thrombosis: low pressure, fibrin rich–> lead PE, DVT

Question 3

Tx of arterial vs venous thrombosis?

Answer 3

Arterial: anti-platelet
Venous: anticoagulant

Question 4

Formation of atherosclerotic plaque to thrombosis?

Answer 4

1. Vessel damage
2. Initial fatty streak - lipid accumulation in foamy macrophage in tunica intima
3. Plaque enlargement
4. Turbulence due to protrusion in lumen
5. Loss endothelium and exposure collagen
6. Platelet activation and adherence
7. Fibrin meshwork entrap RBC
8. More turbulence, more deposition

Question 5

RF arterial thrombosis?

Answer 5

Diabetes, hypertension, hyperlipidemia, smoking, AF

Question 6

Management arterial thrombosis?

Answer 6

1. Lifestyle: smoking cessation, exercise, diet
2. Pharmacological: antiplatlets
3. Thrombolysis

Question 7

How does aspirin work?

Answer 7

ANTIPLATELET
Irreversible inhibition cyclo-oxygenase - inhibit production thromboxane (activate platelet)
Life span platelet = 1 week

Question 8

How does clopidogrel work?

Answer 8

ANTIPLATLET

Irreversible ADP mediated platelet inhibition

Question 9

Indication for thrombolysis

Answer 9

MI, life threatening PE

Question 10

2 type of thromoblysis?

Answer 10

1. Drugs - streptokinase
2. Invasive - percutaneous coronary intervention combined 3-12 month DAPT
3. Rehab in all case

Question 11

What is AF and how does it cause stroke?

Answer 11

Atrial fibrillation - irregular heart rhythm can lead to arterial thrombus and embolism leading to stroke

Blood pool atria –> blood clot form –> blood clot break off –> travel to brain and block cerebral artery

Question 12

Tx AF

Answer 12

DC cardioversion

Heart rate control

Question 13

How do venous thrombosis form?

Answer 13

Virchow’s triad

1. Hyper-coagulability
2. Stasis
3. Vessel wall damage

Question 14

RF venous thrombosis?

Answer 14

Heritable: FAPP - factor V leaden, antithrombin deficiency, protein C/S deficiency, prothrombin mutation

Acquired: age, previous VTE, major surgery or trauma, pregnancy, OCP, obesity

Question 15

Prevention strategies for venous thrombosis?

Answer 15

1. Hydration and mobilisations
2. Mechanical prophylaxis: elastic compression, pneumatic compression
3. Chemical prophylaxis: low molecular weight heparin, direct oral anticoagulant

Question 16

Tx venous thromboembolism?

Answer 16

Acute: anticoagulation, thrombolysis, thrombectomy

Long term: anti-coag, stockings