Thrombosis And Anticoagulation 08.01.24

Question 1

Can thrombosis occur in both arterial and venous circulation?

Answer 1

Yes!

Question 2

What is an aetiology for arterial thrombosis?

Answer 2

Atherosclerosis!

Question 3

Treatment for coronary arterial thrombosis

Answer 3

Aspirin (inhibits platelet function) and other anti platelets
LMWH or Fondaparinux or UFH
Thrombolytic therapy: streptokinase tissue plasminogen activator
Reperfusion - catheter directed treatments and stents

Question 4

Treatment for cerebral arterial thrombosis

Answer 4

aspirin, other anti-platelets
Thrombolysis
Catheter directed treatments - reperfusion

Question 5

What are the 4 categories of arterial thrombosis?

Answer 5

Coronary
Cerebral
Peripheral circulation
Other territories

Question 6

Treatment for other territories arterial thrombosis

Answer 6

Antiplatelets, statins
Role of anticoagulants evolving
Endovascular vs surgical

Question 7

What is clopidogrel medication for?

Answer 7

Anti platelet medication

Question 8

What are the 2 categories of venous thrombosis?

Answer 8

Peripheral (ileofemoral, femoral-popliteal) and other sites (cerebral, visceral)

Question 9

Venous thrombosis symptoms

Answer 9

CALF PAIN
CHEST PAIN
BREATHING DIFFICULTIES

Question 10

What is CVA (cerebral vascular accident)?

Answer 10

Means stroke

Question 11

Venous thrombosis aetiology

Answer 11

Virchows triad, genetic (factor V Leiden) or acquired (anti-phospholipid syndrome), endothelium

Question 12

Venous thrombosis treatment

Answer 12

Heparin or LMWH (low molecular weight heparin)
Warfarin
DOAC (direct oral anticoagulants)
Endo-vascular (use catheter to access arteries or vein)
Surgical

Question 13

Venous thrombosis prevention

Answer 13

Mechanical or chemical thromboprophylaxsis
Early mobilisation and good hydration

Question 14

Explain heparin

Answer 14

Given by IV in cannula as continuous infusion, binds to antithrombin and increases activity, short half life

Question 15

Explain low molecular weight heparin

Answer 15

Smaller molecule, less variation in dose and really excreted, once daily, weight-adjusted dose given subcutaneously

Used for treatment and prophylaxis

Question 16

What is UFH (unfractionated heparin )

Answer 16

This like normal heparin

Question 17

What is HIT

Answer 17

Heparin-induced thrombocytopenia

Question 18

Explain warfarin

Answer 18

Orally, prevents synthesis of active factors II, VII, IX and X, antagonist of vitamin K, long half life, prolongs prothrombin time

Question 19

DVT symptoms

Answer 19

Leg pain, swelling

Question 20

DVT signs

Answer 20

Tenderness, swelling, warmth, discolouration

Question 21

DVT complications

Answer 21

PE

Question 22

DVT investigations

Answer 22

D-dimer (normal excludes positive diagnosis it does not confirm diagnosis)
Ultrasound compression
CT or MR venogram

Question 23

DVT treatment

Answer 23

LMW heparin (minimum 5 days)
Oral warfarin
DOAC/NOAC
Compression stockings
Seek underlying cause

Question 24

Prevention of DVT

Answer 24

Mechanical (hydration and early mobilisation, compression stockings, foot pumps) and chemical (LMW heparin)

Question 25

Signs of PE

Answer 25

Tachycardia, tachypnoea, plural rub

Question 26

PE initial investigations

Answer 26

Chest radiography usu/ally normal, ecg sinus tachycardia, blood gases (resp type 1 failure, decreased o2 and co2)’

Question 27

PE treatment

Answer 27

Supportive treatment LMW heparin Oral warfarin for 6 months Treat underlying causes

Question 28

PE prevention

Answer 28

Anticoagulation IVC filters