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2a- Cardiology > Venous thrombosis and anti-thrombotic therapy > Flashcards

Venous thrombosis and anti-thrombotic therapy Flashcards

1
Q

What is thrombosis?

A

Solid mass of blood constituents formed within intact vascular system during life

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2
Q

What are the conditions that allow thrombosis in arterial circulation?

A

high pressure + platelet rich

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3
Q

What are the conditions that allow thrombosis in venous circulation?

A

low pressure + fibrin rich

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4
Q

Where are the 3 main locations for arterial thrombosis?

A

Coronary circulation
Cerebral circulation
Peripheral circulation

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5
Q

What occurs after an arterial thrombosis in the coronary circulation?

A

Pain in left arm, angina, myocardial infarction, sudden death

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6
Q

What occurs after an arterial thrombosis in the cerebral circulation?

A

Slurred speech, headaches, stroke

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7
Q

What occurs after an arterial thrombosis in the peripheral circulation?

A

Pain in leg, gangrene, peripheral vascular disease

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8
Q

What is an example of another territory arterial thrombosis can occur in?

A

Superior mesenteric artery (SMA)

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9
Q

What does an arterial thrombosis in the SMA lead to?

A

Abdominal pain

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10
Q

What is the normal bleeding time?

A

2-9 minutes

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11
Q

What are the causes of arterial thrombosis?

A
  • Atherosclerosis
  • Inflammatory
  • Infective
  • Trauma
  • Tumours
  • Unknown
    • Platelet driven
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12
Q

What is the underlying cause of arterial thrombosis in majority of cases?

A

Atherosclerosis

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13
Q

What are risk factors for atherosclerosis?

A

Smoking
Hypertension
Diabetes
Hyperlipidaemia
Obesity/ sedentary lifestyle
Stress/ type A personality

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14
Q

What are the 3 main presentations of arterial thrombosis?

A
  • Myocardial infarction (MI)
  • CVA
  • Peripheral vascular disease
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15
Q

What is CVA?

A

cerebrovascular accident eg. stroke

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16
Q

How can you diagnose MI?

A
  • History
  • ECG
  • Cardiac enzymes
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17
Q

How can you diagnose CVA?

A
  • History and examination
  • CT scan/ MRI
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18
Q

How can you diagnose peripheral vascular disease?

A
  • History and examination
  • Ultrasound
  • Angiogram
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19
Q

What are the treatments for MI?

A

Aspirin – inhibits platelet function
LMWH
Thrombolytic therapy

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20
Q

What are the treatments for stroke?

A

Aspirin or clopidogrel, tiglacor; anti-platelet
TPA (tissue plasminogen activator) – generates plasmin, degrades fibrin
Treat risk factors

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21
Q

What is LMWH?

A

Low molecular weight heparin

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22
Q

Why is Fondaparinux used instead of heparin?

A
  • Much higher risk of bleeding with heparin
  • Longer half life with fondaparinux
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23
Q

What is DVT?

A

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg

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24
Q

What are the most common DVT signs?

A

Calf pain, chest pain, breathlessness

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25
Q

What type of signs and symptoms are seen in DVT?

A

Non-specific

26
Q

What are causes of venous thrombosis that affect blood flow?

A
  • Immobilisation
  • Surgery
  • Trauma
27
Q

What are causes of venous thrombosis that cause damage to the vessel wall?

A

Injury - chemical, physical

28
Q

What are some genetic causes of venous thrombosis?

A
  • Factor V Leiden
  • Antithrombin deficiency
29
Q

What are some acquired causes of venous thrombosis?

A
  • Anti-phospholipid syndrome
  • Lupus anticoagulant
30
Q

What part of Virchow’s triad do genetic and acquired causes affect?

A

Blood constituents

31
Q

What are the basic symptoms of DVT?

A

Pain, swelling

32
Q

What are the basic signs of DVT?

A

tenderness, swelling, warmth, decolourisation

33
Q

What are risk factors for DVT?

A
  • Surgery, immobility, leg fracture, POP
  • OC pill, HRT, pregnancy
  • Long haul flights
  • Inherited thrombophilia – genetic predisposition (Caucasian)
34
Q

What investigation can be done for DVT?

A

D-dimer
Positive result

35
Q

What else can a positive D-dimer test show?

A

surgery/ pregnancy/ infection
Does not confirm diagnosis of DVT

36
Q

What imaging can be done for DVT?

A
  • Ultrasound compression test proximal veins
  • Venogram by CT or MRI for calf (bigger), recurrence, uncertain
37
Q

How can you mechanically prevent DVT?

A

hydration and early mobilisation, compression stockings, foot pumps

38
Q

How can you chemically prevent DVT?

A

LMWH

39
Q

What is the treatment for DVT?

A
  • Oral warfarin
  • LMWH
  • DOAC (direct oral anticoagulant)
  • Compression stockings
  • Treat underlying cause – malignancy, thrombophilia
40
Q

What is the endo-vascular form of treatment for DVT?

A
  • Catheter inserted into vein
  • Clot either blasted by jet, sucked away etc
41
Q

What is thromboprophylaxis?

A

the prevention of clots forming in the veins

42
Q

What is a PE?

A

Pulmonary embolism

43
Q

What is a pulmonary embolism?

A

A blockage in one of the pulmonary arteries in your lungs, often caused by blood clots that travel to the lungs from the legs (DVTs)

44
Q

What are symptoms of a PE?

A
  • breathlessness
  • pleuritic chest pain
  • symptoms of DVT
  • risk factors for DVT
  • Cyanosis
45
Q

What are signs of a PE?

A
  • tachycardia
  • tachypnoea
  • pleural rub,
  • Signs of DVT
46
Q

What is the common presentation of PE?

A

Differential diagnosis of chest pain and SOB

47
Q

What is the differential diagnosis of PE?

A

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

48
Q

What do initial investigations for PE usually show?

A
  • CXR usually normal
  • ECG sinus tachy
  • Blood gases: type 1 resp failure, decreased O2 and CO2
49
Q

What are further investigations for PE?

A
  • D-dimer: normal excludes diagnosis
  • Ventilation/ Perfusion scan: mismatch defects
50
Q

What is treatment for PE?

A
  • LMW heparin
  • DOAC
  • Oral warfarin
  • Treat the cause
51
Q

How can you prevent PE?

A
  • Anticoagulation
  • IVC (inferior vena cava) filters if anti-coagulating doesn’t work
    • Life saving intervention
52
Q

What are mechanical ways to prevent PE?

A

Similar to prevention for DVT
- Early mobilisation and hydration
- Mechanical mobilisation – foot pumps

53
Q

What are chemical ways to prevent PE?

A

LMWH

54
Q

What are features of a massive PE?

A
  • Haemodynamic instability
  • Rare
55
Q

What can the consequences of a massive PE be?

A

Hypotension, cyanosis, severe dyspnoea, right heart strain/ failure

56
Q

What could you consider for a massive PE?

A

embolectomy

57
Q

What is bridging?

A

unstable medication such as warfarin → stable medication such as LMWH while in-patient → back to unstable warfarin

58
Q

What are features of heparin?

A
  • Given IV, need canula
    • Given by continuous infusion
    • Continuous monitoring
  • Glycoaminoglycan
  • Binds to antithrombin and increases its activity
  • Indirect thrombin inhibitor
  • Short half life
    • If you stop it, action wears off quickly
59
Q

What are features of LMWH?

A
  • Smaller molecule, less variation in dose and renally excreted
  • Once daily, weight-adjusted dose given subcutaneously
    • Subcutaneous usually in
      stomach
  • Used for treatment and prophylaxsis
60
Q

What are features of warfarin?

A
  • Orally active
  • Prevents synthesis of active factors II, VII, IX and X
  • Antagonist of vitamin K
  • Long half life (36 hours)
  • Prolongs the prothrombin time
  • Difficult to use
  • Individual variation in dose
  • Need to monitor
61
Q

What are features of DOACs?

A
  • Orally active
  • Directly acting on factor II or X
  • No blood tests or monitoring
  • Shorter half lives so bd or od
  • Used for extended thromboprophylasis and treatment of AF and DVT/PE
  • Not used in pregnancy
  • Measure anti 10a levels to see function
62
Q

What are features of 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

2a- Cardiology (7 decks)

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