Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

cardio lectures phase 2 > thrombosis and anticoagluation > Flashcards

thrombosis and anticoagluation Flashcards

1
Q

what is rthrombosis

A

blood coagulation inside a vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what should you not confuse thrombosis with

A

when there is appropriate coagluation when blood escapes a vessel, failiure of coagulation in this situation leads to bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how does thrombosis occur in arterial circulation

A

high pressure - platelet rich

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how does thrombosis occur in venous circulation

A

low pressure - fibrin rich

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

where does arterial thrombosis occur anatomically

A
  • coronary circulation
  • cerebral circulation
  • peripheral circulation
  • other territories
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

symptoms of thrombosis in coronary circulation

A

angina
shoulder pain
left arm pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

symptoms of thrombosis in cerebral circulation

A

slurred speech
weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

symptoms of arterial thrombosis in peripheral circulation

A

pain in the leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what other territories can u get arterial thrombosis

A

superior mesenteric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

etiology of arterial thrombosis

A

atherosclerosis - main one
inflammatory
infective
trauma
tumours
unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

presentation of arterial thrombosis

A

myocardial infarcation
CVA - stroke
peripheral vascular disease
others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

treatment of coronary arterial thrombosis

A

Aspirin and other antiplatelets - first line
– LMWH or Fondaparinux or UFH

– Thrombolytic therapy: streptokinase
tissue plasminogen activator

– Reperfusion – Catheter directed treatments and stents

Aspirin inhibits platelet function
TPA generates plasmin, degrades fibrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why is fondaparinux used instead of heparin

A

fondaparinux - prevents blood clotting

much higher risk of bleeding from heparin

fondaparinux has much higher half life too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

treatment of cerebral arterial thrombosis

A

Aspirin, other anti-platelets - first line

Thrombolysis - for stroke

Catheter directed treatments Reperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why is heparin not used in patients who have had strokes

A

too much bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

treatment for arterial thrombosis in other sites

A

• Antiplatelets, statins
• Role of anticoagulants evolving
• Endovascular vs Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

anatomy of peripheral venous thrombosis

A

from ileofemoral to femoro-popliteal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

non specific signs and symptoms of venous thrombosis

A

calf pain, chest pain, breathless
most common DVT signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what tests to diagnose venous thrombosis

A

D dimer blood test
it is sensitive but not specific

imaging is usually required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3 components of virchow trials

A

blood flow
endothelium
blood constituents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what can change blood flow

A

immobilisation
surgery
long haul flights
trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what can affect endothelium

A

injury - physical, chemical

23
Q

genetic blood constituents

A

• Factor V Leiden (5%)
• PT20210A (3%)
• Antithrombin deficiency • Protein C deficiency
• Protein S deficiency

24
Q

acquired blood constituents

A

• Anti-phospholipid syndrome
• Lupus anticoagulant
• Hyperhomocysteinaemia

25
Q

other blood constituteunts

A

malignancy
oestrogens

26
Q

treatment of venous thrombosis

A

heparin or LMWH
warfarin
DOAC
endovascular - taken over surgical, catheter inserted into vein which gets rid of clot
surgical - very rare

27
Q

main treatment for DVT

A

DOAC

direct oral anti coagluation

tablets - dont have to monitor

28
Q

prevention of venous thrombosis

A

• Mechanical or chemical thromboprophylaxsis
• Also early mobilisation and good hydration

29
Q

what does heparin do

A

binds to antithrombin and increases its activity

indirect thrombin inhibitor

30
Q

describe half life of heparin

A

short half life

31
Q

how to monitor heparin

A

continuous monitoring with APTT, aim ratio 1.8-2.8

its given by IV, need cannula, continuous infusion

32
Q

describe low molecular weight heparin

A

easier to give
smaller molecule
less variation in dose and really excreted
once daily, weight adjusted dose given subcutaneously,
used for treatment and prophylaxis

33
Q

what does warfarin do

A

prevents synthesis of active factors II, VII, IX and X

prolongs the prothrombin time

34
Q

what is warfarin an antagonist of

A

vitamin k

35
Q

half life of warfarin

A

long - 36 hours

36
Q

how to give warfarin

A

• Difficult to use,
- individual variation in dose.
• Need to monitor
• Measure INR (international normalised ratio, derived from prothrombin time)
• Usual target range 2-3, • Higher range 3-4.5

37
Q

describe DOAC

A

directly acting on factor II or X
no blood tests or monitoring
orally active
shorter half life’s

38
Q

what are DOAC used for

A

extended thromboprophylasis and treatment of AF and DVT/PE

not used in pregnanc

39
Q

describe aspirin

A

• Inhibits cyclo-oxygenase irreversibly
• Act for lifetime of platelet, 7-10 days
• Inhibits thromboxane formation and hence platelet aggregation
• Used in arterial thrombosis, 75-300 mg od

40
Q

other anti platelets

A

• Clopidogrel -inhibits ADP induced platelet aggregation by irreversibly binding to the p2y12 receptors
• Ticagrelor – p2y12 receptor antagonist • Prasugrel – p2y12 receptor antagonist

41
Q

how many people die of DVT and PE a year in UK

A

25000

42
Q

DVT diagnosis

A

• Symptoms: leg pain, swelling
• Signs: tenderness, swelling, warmth, discolouration
• Complications: Phlegmasia Alba Dolens and Phlegmasia Cerulae Dolens, PE

43
Q

DVT investigatio

A

• D-dimer: normal excludes diagnosis positive does not confirm diagnosis
• Ultrasound compression • CT or MR venogram
catheter venogram?

44
Q

DVT treatment

A

• LMW Heparin (for min 5 days)
• Oral warfarin (INR 2-3) for 3-6 months
• Or DOAC/NOAC
• Compression stockings – symptoms vs PTS • Treat/ seek underlying cause
• Spontaneous vs provoked

45
Q

endovenous recannalisation

A

chemical;
mechanical
mechanic- chemical
stents

46
Q

prevention of DVT

A

• Mechanical- hydration and early mobilisation, Compression stockings, Foot pumps
• Chemical- LMW Heparin

47
Q

SYMOPTOM OF pulmonary embolism

A

breathlessness, pleuritic chest pain

48
Q

signs of pulmonary embolism

A

tachycardia, tachypnoea, pleural rub,

49
Q

differential; diagnosis of Pulmonary embolism

A

Musculoskeletal, Infection, Malignancy, Pneumothorax, Cardiac, GI causes

50
Q

initial investigations for pulmonary embolism

A

• CXR usually normal
• ECG sinus tachy, (QI,SI,TIII)
• Blood gases: type 1 resp failure, decreased O2 and CO2
• Mainly done to exclude alternative causes

51
Q

further investigations for pulmonary embolism

A

D-dimer: normal excludes diagnosis
• CTPA spiral CT with contrast, visualise major segmental thrombi

52
Q

treatment of pulmonary embolism

A

• Supportive treatment
• LMW Heparin
• Oral warfarin (INR 2-3)for 6 months • DOAC/NOAC
• Treat underlying cause

53
Q

prevention of pulmonary embolism

A

anti coagluation
IVC filter

cardio lectures phase 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions