BL - Hereditary and Acquired Thrombotic Disorders

Question 1

Thick muscular vessel
High pressure/
flow
High oxygen

Answer 1

Artery

Question 2

Thin, pliable vessel
Low pressure/slow flow
Low oxygen

Answer 2

vein

Question 3

Platelets more important in

Answer 3

Arterial

Question 4

Blood clotting factors more important in

Answer 4

Venous

Question 5

Virchow’s Triad

Answer 5

VENOUS STASIS
ALTERED VESSELS
ALTERED COAGULABILITY

Question 6

Trauma
Post-surgery
Immobility/Inactivity
Obesity
Pregnancy
Estrogens/Birth control
Malignancy
Age

Answer 6

Risk Factors for Venous Thrombosis

Question 7

• Factor V Leiden
• Prothrombin gene mutation
• Protein C deficiency
• Protein S deficiency
• Antithrombin deficiency

These are all?

Answer 7

Inherited hypercoagulable disorders

Risk Factors for Venous Thrombosis

Question 8

~inflammatory damage
~mechanical injury
~hypoxia

Answer 8

ALTERED VESSELS

Question 9

-clotting factors ( increased factors VII, VIII, XI)
-hematologic disorders
-**Malignancy
Vasculitic/proinflammatory disorders
-Disseminated intravascular coagulation ( DIC)

Answer 9

Acquired hypercoagulable states

Risk Factors for Venous Thrombosis

Question 10

SOB, acute versus gradual
Diminished exercise capacity
chest pain
syncope
cardiac arrest/death

Answer 10

Pulmonary embolism (PE)

Question 11

-impaired venous return with blood flow
edema develops due to increased hydrostatic pressure, pain present

• blood flow through alternative routes leads to dilated superficial veins
• redness and warmth of the affected area

Answer 11

Venous thrombosis-Limb

Question 12

~immobility
~paralysis
~reduced flow states

Answer 12

VENOUS STASIS

Question 13

Blood work for DVT concerns

Answer 13

• elevated D-Dimer*

- Negative D-Dimer rules out thrombosis

Question 14

Acquired hypercoagulable states

Answer 14

• clotting factors ( increased factors VII, VIII, XI)
• hematologic disorders
• **Malignancy
• Vasculitic/proinflammatory disorders
• Disseminated intravascular coagulation ( DIC)

Question 15

Inherited hypercoagulable disorders

Answer 15

• Factor V Leiden
• Prothrombin gene mutation
• Protein C deficiency
• Protein S deficiency
• Antithrombin deficiency

Question 16

~inflammatory stimuli

~consumption of endogenous anticoagulants

Answer 16

ALTERED COAGULABILITY

Question 17

VENOUS STASIS
ALTERED VESSELS
ALTERED COAGULABILITY

Answer 17

Virchow’s Triad

Question 18

Treatment for acute clot is:_____

Answer 18

heparin/tPA

Question 19

_____ used to prevent additional clots

Answer 19

Warfarin

Question 20

Strongest risk factor for clot?

Answer 20

Malignancy

Question 21

D-dimers can only be formed when crosslinked fibrin has been degraded by plasmin through ______.

Answer 21

fibrinolysis

Question 22

Do blood clots form in the lung?

Answer 22

Nope, they travel there

Question 23

For arterial thrombi, in the acute setting, heparin (to prevent further clot formation) and a fibrinolytic
agent such as______(to lyse the existing clot) are indicated

Answer 23

tPA

Question 24

D-dimers can only be formed when crosslinked fibrin has been degraded by _____through fibrinolysis.

Answer 24

plasmin

Question 25

Warfarin acts by inhibiting the activity of ______dependent enzymes (Factors II, VII, IX, X, Protein C, Protein S)

Answer 25

vitamin K

Question 26

thrombus can break off and travel through major veins, right heart into pulmonary artery until it becomes lodged

Answer 26

PE

Question 27

Blood flow through pulmonary artery is impaired by thrombus, Lung tissue past thrombus cannot participate in gas exchange, tissue can:

Answer 27

infarct (Pulmonary infarct)

Question 28

Warfarin acts by inhibiting the activity of vitamin K dependent enzymes (Factors ____________)

Answer 28

II, VII, IX, X, Protein C, Protein S

Question 29

Increased pulmonary vascular resistance can lead to_______

Answer 29

right ventricular dysfunction

Question 30

Increased airway resistance d/t bronchoconstriction

Answer 30

Decreased pulmonary compliance | in PE

Question 31

If clot burden is high ( saddle embolus-both PA affected)->

Answer 31

cardiovascular arrest and death in PE

Question 32

______ inactivates activated clotting factors

Answer 32

Heparin

Question 33

Warfarin______ treat the acute clot-do not give alone for acute event!

Answer 33

does NOT

Question 34

Reduction of vitamin K by warfarin dependent factors takes at least____ days regardless of INR

Answer 34

4-5

Question 35

Due to an autosomal dominant mutation of the factor V gene that leads to partial resistance to inactivation through proteolytic cleavage by protein C.

Answer 35

Factor V Leiden (Activated Protein C Resistance)

Question 36

vitamin K-dependent plasma protein that, when activated, inactivates factors Va and VIIIa to inhibit coagulation. Deficiency is inherited in an autosomal dominant fashion.

Answer 36

Protein C Deficiency

Question 37

vitamin K-dependent plasma protein that facilitates the anticoagulant activity of activated protein C. As with protein C, deficiency is inherited as an autosomal dominant trait.

Answer 37

Protein S Deficiency

Question 38

regulates coagulation by inactivating thrombin as well as factors Xa, IXa, XIa and XIIa. deficiency is inherited in an autosomal dominant fashion.

Answer 38

Antithrombin Deficiency

Question 39

Oral anticoag drug?

Answer 39

Warfarin/ Coumadin

Question 40

-Pregnancy -active thrombosis -DIC -nephrotic syndrome -use of warfarin -birth control Can cause?

Answer 40

Acquired low levels occur of Protein S

Question 41

provokes blood thrombosis in a/v as well as pregnancy-related complications The diagnostic criteria require one clinical event, i.e. thrombosis or pregnancy complication, and two blood tests spaced at 12 weeks apart that test positive for one of the three antibodies

Answer 41

Antiphospholipid syndrome

Question 42

Is factor 5 Leiden a deficiency

Answer 42

NO it is a mutation Protein C cant break down this factor 5 it sticks around and clots

Question 43

Anticardiolipin Antibodies Lupus anticoagulant Beta2-glycoprotein-I antibodies

Answer 43

Antiphospholipid syndrome positive for one of these three antibodies

Question 44

Antiplatelet therapy for arterial thrombosis | ______ therapy for venous thrombosis

Answer 44

Anticoagulant

Question 45

Most inherited hypercoagulable states do not cause:

Answer 45

arterial thrombosis

Question 46

______ therapy for arterial thrombosis | Anticoagulant therapy for venous thrombosis

Answer 46

Antiplatelet