Thrombotic Disorders Flashcards Preview

Module 103: Theme 2 > Thrombotic Disorders > Flashcards

Flashcards in Thrombotic Disorders Deck (26):
1

Deep veins in leg

Iliac, femoral, popliteal, tibial

2

Superficial leg veins

Greater saphenous, lessor saphenous

3

DVT

deep vein thrombosis

4

Thrombotic risk factors

Post-op (orthopaedic)
Hospitalisation
Pregnancy
OCP
Long haul flights
Cancer
Obesity
Drug abuse

5

Presentation of DVTs

Unilateral calf swelling/ heat/ pain/ redness/ hardness
Cellulitis
Baker's cyst
Muscular pain

6

Doppler ultrasound

ultrasound transducer produces a real time 2D image of soft tissue structure
Colour duplex shows velocity and direction of blood flow
Veins are non-compressible by U/S probe

7

Birchow's triad of thrombosis

Circulatory stasis, hypercoagulable state, endothelial injury

8

D dimer test

Likelihood of having a DVT can be assessed
Indicate activation of clotting cascade
Low wells score and negative d-dimer test have high negative predictive values

9

Initial DVT treatment

Therapeutic anti-coagulation using sub-cat LMW (low molecular weight) heparin
Dosing done according to patients weight
If someone has renal impairment then anti-coagulate with IV unfractionated heparin

10

Subsequent DVT treatment

Load patient with oral warfarin for 3-5 days
Stop LMW heparin once INR is over 2 for 2 days

11

1st femoral/ iliac DVT

Secondary treatment: 6 months warfarin

12

2nd DVT/PE

Treatment: lifelong warfarin

13

Target INR

Between 2-3 (2.5)

14

PE symptoms

Pleuritic pain
Dyspnoea
Haemoptysis

15

PE on examination

tachycardia, tachypnoea, hypotensive

16

Massive PE

Sycope, death

17

CPTA

CT pulmonary angiogram

18

Saddle embolism

Large pulmonary thrombo-embolism that straddles the main pulmonary arterial trunk at its bifurcation

19

V/Q scans

Radio isotope shows under-perfusion (V/Q mismatch) due to PE
Indeterminate scans - can't tell what the underlying cause is so rarely done

20

ECG

Shows sinus tachycardia, atrial fibrillation, right heart strain

21

Chest X-ray

Usually normal, shows linear atelectasis, small effusions

22

PE outcomes

5% mortality with treatment 4% develop pulmonary hypertension
Leading cause of preventable death

23

Treatment of massive PE

Thrombolysis and IV heparin
2-6% risk of serious bleeding

24

Treatment of standard PE

LMW heparin injections (Tinzaparin)
Warfirin for 6 months
Inferior VC filters
Consider DOAC (NOACs) as alternatives

25

LMW heparin better if

There is an underlying cancer

26

Thrombophilia screen

Done in younger patients
Can be inherited:
Factor 5 leiden, prothrombin gene variant, anti-thrombin deficiency, protein C and S deficiency

Can be acquired from anti-phospholipid syndrome