BL - Hereditary and Acquired Thrombotic Disorders Flashcards Preview

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Flashcards in BL - Hereditary and Acquired Thrombotic Disorders Deck (46):
1

Thick muscular vessel
High pressure/
flow
High oxygen

Artery

2

Thin, pliable vessel
Low pressure/slow flow
Low oxygen

vein

3

Platelets more important in

Arterial

4

Blood clotting factors more important in

Venous

5

Virchow’s Triad

VENOUS STASIS
ALTERED VESSELS
ALTERED COAGULABILITY

6

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

Risk Factors for Venous Thrombosis

7

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

These are all?

Inherited hypercoagulable disorders

Risk Factors for Venous Thrombosis

8

~inflammatory damage
~mechanical injury
~hypoxia

ALTERED VESSELS

9

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

Acquired hypercoagulable states

Risk Factors for Venous Thrombosis

10

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

Pulmonary embolism (PE)

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

Venous thrombosis-Limb

12

~immobility
~paralysis
~reduced flow states

VENOUS STASIS

13

Blood work for DVT concerns

-elevated D-Dimer*

-Negative D-Dimer rules out thrombosis

14

Acquired hypercoagulable states

-clotting factors ( increased factors VII, VIII, XI)

-hematologic disorders

-**Malignancy

-Vasculitic/proinflammatory disorders

-Disseminated intravascular coagulation ( DIC)

15

Inherited hypercoagulable disorders

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

16

~inflammatory stimuli
~consumption of endogenous anticoagulants

ALTERED COAGULABILITY

17

VENOUS STASIS
ALTERED VESSELS
ALTERED COAGULABILITY

Virchow’s Triad

18

Treatment for acute clot is:_____

heparin/tPA

19

_____ used to prevent additional clots

Warfarin

20

Strongest risk factor for clot?

Malignancy

21

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

fibrinolysis

22

Do blood clots form in the lung?

Nope, they travel there

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

tPA

24

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

plasmin

25

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

vitamin K

26

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

PE

27

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

infarct (Pulmonary infarct)

28

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

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

29

Increased pulmonary vascular resistance can lead to_______

right ventricular dysfunction

30

Increased airway resistance d/t bronchoconstriction

Decreased pulmonary compliance
in PE

31

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

cardiovascular arrest and death in PE

32

______ inactivates activated clotting factors

Heparin

33

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

does NOT

34

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

4-5

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.

Factor V Leiden (Activated Protein C Resistance)

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.

Protein C Deficiency

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.

Protein S Deficiency

38

regulates coagulation by inactivating thrombin as well as factors Xa, IXa, XIa and XIIa.

deficiency is inherited in an autosomal dominant fashion.

Antithrombin Deficiency

39

Oral anticoag drug?

Warfarin/ Coumadin

40

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

Acquired low levels occur of Protein S

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

Antiphospholipid syndrome

42

Is factor 5 Leiden a deficiency

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

43

Anticardiolipin Antibodies
Lupus anticoagulant
Beta2-glycoprotein-I antibodies

Antiphospholipid syndrome positive for one of these three antibodies

44

Antiplatelet therapy for arterial thrombosis
______ therapy for venous thrombosis

Anticoagulant

45

Most inherited hypercoagulable states do not cause:

arterial thrombosis

46

______ therapy for arterial thrombosis
Anticoagulant therapy for venous thrombosis

Antiplatelet