Haematology 8 - Thrombosis: aetiology and management Flashcards

1
Q

What is the triad of symptoms in thrombophlebitic syndrome?

A

Recurrent pain
Swelling
Ulcers

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2
Q

What catalyses the conversion of fibrinogen to fibrin?

A

Thrombin

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3
Q

Which anticoagulant molecules are expressed on the blood vessel wall?

A

Thrombomodulin
Endothelial Protein C receptor
TFPI

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4
Q

How does inflammation affect the blood vessel wall?

A

It makes it prothrombotic

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5
Q

Recall 5 effects of inflammation on the blood vessel wall

A
  1. Anticoagulant molecules are downregulated
  2. TF expressed
  3. Prostacyclin decreased
  4. Adhesion molecules upregulated
  5. VWF released (leading to neutrophil capture, and formation of NETs)
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6
Q

How do neutrophils contribute to immunothrombosis?

A

Neutrophils release DNA, which is procoagulant

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7
Q

What is the mechanism of action of clopidogrel?

A

Inhibits ADP receptors

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8
Q

Give 4 ways in which blood stasis promotes thrombosis

A
  1. Accumulation of activated factors
  2. Promotes platelet adhesion
  3. Promotes leukocyte adhesion and transmigration
  4. Hypoxia produces inflammatory effect on endothelium
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9
Q

What is the broad mechanism of action of heparins?

A

Potentiate antithrombin

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10
Q

What is one risk of long term heparin use?

A

Osteoporosis

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11
Q

Give an example of an anti-Xa drug

A

Rivaroxaban

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12
Q

Give an example of an anti-IIa drug

A

Dabigatran

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13
Q

How does warfarin affect vit K?

A

Prevents recycling of Vit K

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14
Q

Which procoagulant factors fall as a result of warfarin medication?

A

II, VII, IX and X

Also Protein C and Protein S

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15
Q

How is warfarin monitored?

A

INR measure

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16
Q

Why should warfarin never be given to pregnant women?

A

It is teratogenic

17
Q

Give an example of an LMWH

A

Enoxaparin/ Tinzaparin

18
Q

What scoring system is used to calculate risk of thrombosis?

A

Chads-vasc

19
Q

Which surgeries carry the highest risk of thrombosis?

A

Orthopaedic

20
Q

Which surgeries carry highest risk of bleeding?

A

Neuro, spinal or eye surgery

21
Q

Which class of anti-coagulants carries a significantly lower risk of intracranial bleeding?

A

DOACs

22
Q

What is the best drug to use as a long-term anticoagulant in a patient who has had an idiopathic VTE?

A

DOACs

23
Q

Recall 3 minor precipitants of thrombosis

A

COPD
flights
trauma

24
Q

After someone has suffered a thrombosis due to a minor precipitant, how long should they be anti-coagulated for?

A

3 months

25
Q

Recall the order in which the different coagulation factors in the intrinsic pathway catalyse each other?

A
12
11
9
8
10
26
Q

Which coagulation measure is used to monitor heparin therapy?

A

APTT

27
Q

Which coagulation measure is used to monitor warfarin therapy?

A

PT (INR)

28
Q

Which factor does the extrinsic pathway start with?

A

Seven