Venous Thrombosis

Question 1

Venous thrombosis types (2)

Answer 1

DVT,

PE

Question 2

Arterial thrombosis types

Answer 2

coronary,
cerebral,
peripheral

Question 3

Arterial thrombosis formation and clot type

Answer 3

piece of arthersclerosis breaks off, collagen exposed and then platelet rich thrombus comes and occludes vessel

Question 4

Treatment for arterial thrombosis

Answer 4

aspirin and other anti-platelets drugs

Question 5

Arterial high pressure/low pressure venous high/low pressure

Answer 5

venous low

Question 6

Venous thrombosis formation and clot type

Answer 6

valves deteriorate meaning blood stasis which activates coagulation cascade so platelets not activated but clot is rich in fibrin

Question 7

Virchows triad and venous thrombosis

Answer 7

stasis,
vessel wall (degenerating valves e.g. old age, previous DVT)
hypercoagulability (higher levels of acute phase proteins e.g. CRP, VIII, TF, vWF due to inflammation etc )

Question 8

Treatment for venous thrombosis

Answer 8

heparin,
warfarin,
new oral anticoagulants

Question 9

Highest risk factor for DVT?

Answer 9

history of previous DVT

Question 10

DVT presentation

Answer 10

hot, swollen, tender limb,

pitting oedema

Question 11

PE pattern of events including heart

Answer 11

pulmonary infarction, 
pleuritic chest pain, 
Cardiovascular collapse/death, 
hypoxia, 
right heart strain

Question 12

Risk of VTE

Answer 12

1/1000 per year

Question 13

lifetime risk of VTE

Answer 13

2.5%

Question 14

Risk factors for Venous thromboembolism (11)

Answer 14

age, 
obesity, 
pregnancy, 
puerperium, 
oestrogen therapy, 
previous DVT/PE, 
trauma/surgery, 
malignancy, 
paralysis, 
infection, 
thrombophilia

Question 15

Clotting factors rise/fall in pregnancy to reduce bleeding?

Answer 15

rise

Question 16

Which components of normal haemostatic system is most commonly dysfunctional in thrombophilia?

Answer 16

anticoagulant defences abnormal

Question 17

Which 7 risk factors for VT are under stasis

Answer 17

age, 
obesity, 
pregnancy, 
trauma/surgery, 
malignancy, 
paralysis, 
previous DVT/PE

Question 18

Which 2 particular risk factors fall under vessel wall damage?

Answer 18

age,

previous DVT/PE

Question 19

Which 8 risk factors fall under hypercoagulability?

Answer 19

age, 
pregnancy, 
puerperium, 
oestrogen therapy, 
trauma/surgery, 
malignancy, 
infection, 
thrombophilia

Question 20

Hypercoagulability are associate with release of what and raised what? (3)

Answer 20

release of tissue factor,

raised vWF and factor VIII

Question 21

Thrombophilia definition?

Answer 21

familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis

Question 22

What is the most common mechanism of thrombphilia?

Answer 22

Decreased anticoagulant activity

Question 23

What type of naturally occurring anticoagulant is anti-thrombin?

Answer 23

Serine protease inhibitor

Question 24

What does anti-thrombin switch off?

Answer 24

thrombin, 
TF/VII,
V/X. 
VII,
IX

Question 25

Which is main protein and which is cofactor - protein c and protein s?

Answer 25

Protein C is main one and protein s is cofactor

Question 26

How do protein c and protein s switch of clotting pathway?

Answer 26

When haemostasis achieved thrombin binds to thrombomodulin which changes function from being protein involved in forming fibrin to switch on protein c and s. these inhibit factor V and factor VIII

Question 27

Commonest inherited blood clotting disorder? How does it cause VT?

Answer 27

Factor V Leiden - factor V slightly mutated, works normally but isn't switched off as efficiently by protein c/s and so have x5 increased risk of VT

Question 28

List the 5 hereditary thrombophilias?

Answer 28

``` factor V leiden, prothrombin 20210 mutation, antithrombin deficiency, Protein C deficiency, protein S deficiency ```

Question 29

In what cases would you consider hereditary thrombophilia screening? (5)

Answer 29

``` venous thrombosis <45 years, recurrent venous thrombosis, unusual venous thrombosis, FH of venous thrombosis, FH of thrombophilia ```

Question 30

Management of hereditary thrombophilia? (4)

Answer 30

advice on avoiding risk, short term prophylaxis for periods of risk, short term anticoagulation to treat thrombotic events, long term Anticoagulation if recurrent thrombotic events

Question 31

When do you give long term anticoagulation to those with hereditary thrombophilia? What are you trying to balance?

Answer 31

if RECURRENT thrombotic events, | risk of recurrent thrombosis vs risk of serious haemorrhage

Question 32

Clinical history is less important than the results if thrombophilia screening are positive. T/F?

Answer 32

False! Clinical history much more important

Question 33

List factors from clinical history that indicate higher risk of recurrent thrombosis starting at highest risk (4)

Answer 33

history of previous thrombosis, spontaneous thrombosis rather than acquired transient risk factor, FH, thrombophilia screen results

Question 34

Give an example of an acquired thrombophilia?

Answer 34

antiphospholipid antibody syndrome

Question 35

APS is a stronger risk factor for thrombosis than the hereditary thrombophilias. T/F?

Answer 35

True

Question 36

List 3 main features of APS

Answer 36

recurrent thromboses (arterial and venous), recurrent fetal loss, mild thrombocytopenia

Question 37

Pathogenesis of APS

Answer 37

Antibodies lead to a conformational change in β2 glycoprotein 1 (a protein with unknown function in health) which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities.

Question 38

antiphospholipid antibodies

Answer 38

listen to let

Question 39

screening tests for APS

Answer 39

listen to lec

Question 40

investigations for aps (3)

Answer 40

Levels of aCL, anti-beta2 GPI or lupus anticoagulant (LA) on two occasions at least 12 weeks apart, FBC: thrombocytopenia, haemolytic anaemia, Clotting screen

Question 41

List 5 conditions associated with antiphospholipid antibodies

Answer 41

``` autoimmune disorders, lymphoproliferative disorders, viral infections, drugs, primary (listen to lector's) ```

Question 42

Treatment of APS

Answer 42

aspirin warfarin (listen to lector's)