Thrombotic disorders Flashcards Preview

103T2- Formation, composition, function and disorders of the blood > Thrombotic disorders > Flashcards

Flashcards in Thrombotic disorders Deck (14):
1

What are the three main veins where a DVT is likely to occur?

Femoral vein, popliteal vein, tibial vein

2

Outline Virchows triad

Endothelial injury
Circulatory stress
Hyper-coagulable state

Virchow's triad describes the three broad categories of factors that are thought to contribute to thrombosis.

3

State 3 risk factors for thrombosis

Hospitalisation
Post-op
Pregnancy
OCP
Long haul flights
Cancer
Obesity
Drug use

4

What are the clinical presentations of a thrombosis?

Asymptomatic
Unilateral calf swelling/heat/pain/redness/hardness
Differential diagnosis: cellulitus, Baker's cyst, muscular pain
POTENTIALLY FATAL (approx. 1000 deaths/year)

5

Why would a doppler ultrasound be aa good diagnostic tool for thrombosis?

Produces real-time 2D image of soft tissue stuctures
Colour duplex shows velocity and direction of blood flow
Veins non-compressible by U/S probe

6

How is the d-dimer test used in diagnosis of thrombosis?

Likelihood of having a DVT can be assessed using the Wells risk score & D-dimers test
D-dimers indicate activation of clotting calscade
Low Wells score & negative d-dimer test have high negative predictive value (>99% NPV)

7

What is the initial treatment for thrombosis?

Therapeutic LMW Heparin (Tinzaparin or enoxaparin)

If renal impairment anti-coag with IV unfractionated heparin

8

What subsequent treatment for thrombosis would you give?

Load patient with oral warfarin for 3-5 days
Stop LMW Heparin once INR > 2 for 2 days
if 1st DVT in femoral or iliac- 6 months warfarin
if 2nd DVT/PE- lifelong warfarin
Maintain INR between 2-3

9

What are the clinical signs of a PE?

Pleuritic pain (chest pain)
Dyspnoea
Haemoptysis

In massive PE: collapse, syncope, death
Micro-emboli: asymptomatic
On examination: Tachycardia, tachypnoe, hypotensive

10

Which three investigations may be of interest when dealing with a suspected PE?

1. v/q scan

2. ECG

3. Chest X-ray ( although this is normal as it measure airation)

11

What are the likely outcomes of PE?

5% mortality, 4% develop pulmonary hypertension
Death in 10-30% in-patients
Up to 60% of patients have a micro-emoboli at post mortem
Preventable death

12

What treatment is given in the case of a massive PE?

Treat signs of shock
Thrombolysis and IV Heparin

13

What treatment is given in the case of a standard PE?

LMW Heparin injections e.g. Tinzaparin (better if underlying cancer)
Warfarin 6 months
Consider DOAC

14

Suggest an acquired and inherited condition that could increase risk of thrombosis

Acquired: Anti-phospholipid syndrome

Inherited: F-V Leiden, Pro-thrombin gene variant, anti-thrombin (protein C/S Deficiency)