Term
| Describe the response of a vessel wall after injury |
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Definition
1. Vasoconstriction
2. Formation of platelet plug
3. Regulation of coagulation and fibrinolysis |
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Term
| List the steps of primary hemostasis |
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Definition
1. Adhesis
2. Activation (with TXA2, ADP, Fibronogen, vWF)
3. Aggregation |
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Term
| Define secondary hemostasis |
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Definition
| Over several minutes, the coagulation cascade occurs in fibrin clot formation and degradation |
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Term
| List steps of the intrinsic pathway |
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Definition
Factor 12 is initiated at a negatively charged surface
Activates factor 11
Factor 11 activates factor 9
9a activates 8
8 activates X |
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Term
| List steps of the extrinsic pathway |
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Definition
Factor 7 activates factor 2
Factor 2a activates factor 10 |
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Term
|
Definition
It activates factor 2
Factor 2a converts fibronogen to fibrin |
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Term
| What is the action of plasminogen? |
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Definition
| Once plasminogen is activated by tissue plasminogen activator or urokinase, plasmin will break down fibrin |
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Term
| List four inhibitors of the clotting cascade |
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Definition
AT: Antithrombin III
PC: Protein C
PS: Protein S
PAI: Plasminogen activator inhibitor |
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Term
|
Definition
1. Vascular injury
2. Stasis (abnormal blood flow)
3. Hypercoagulability
Leads to increased change of thrombosis |
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Term
|
Definition
Arterial thrombosis in areas of rapid flow
More plalets
MI, CVA, TIA |
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Term
|
Definition
Venous clots
Almost entirely fibrin
DVT, PE |
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Term
|
Definition
| Venous thromboembolism- DVT or PE |
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Term
| List risk factors for any kind of VTE |
|
Definition
Age >40
History of venous thrombosis |
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Term
| List risk factors for vascular injury VTE |
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Definition
Trauma
Major orthopedic surgery |
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Term
| List risk factors for stasis VTE |
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Definition
Major medical illness
Major surgery
Paralysis/immobility
Obesity
Varicose veins |
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Term
| List risk factors for hypercoagulability VTE |
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Definition
Malignancy (A)
Inflammatory bowel disease (A)
Hormone therapy (T)
Pregnancy (T)
Antiphospholipid antibody syndrome (A)
Factor V Leiden (Activated protein C resistance) (I)
Protein C deficiency (I)
Protein S deficiency (I)
Antithrombin III deficiency (I) |
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Term
|
Definition
| Patients with VTE and no known risk factors |
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Term
| List the clinical course of VTE |
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Definition
i.Remains asymptomatic
ii.Spontaneously lyses
iii.Obstructs the venous circulation
iv.Propagates into more proximal veins
v.Embolizes
vi. Or acts in any combination of the above |
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Term
| What are the two types of lower extremity DVT? |
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Definition
| distal (below knee) or proximal (at knee or above) |
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Term
| What are signs/symptoms of a DVT? |
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Definition
| Edema, tenderness, pain, erythema, warmth, often unilateral |
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Term
|
Definition
| Pain behind the knee or calf upon dorsiflexion of the foot- indicative of a DVT |
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Term
| What are some complications of a DVT? |
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Definition
Acute: PE, limb viability
Chronic: recurrent VTE, post-thrombotic syndrome, |
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Term
| List signs and symptoms of a PE |
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Definition
chest pain, dyspnea, tachypnea, tachycardia, hemoptysis
palpitations, cough, diaphoresis, low-grade fever, hypotension
3. Ominous signs: cardiovascular collapse (characterized by cyanosis, shock, and oliguria) |
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Term
| What are some complications of a PE? |
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Definition
Acute: death, right ventricular dysfunction
Chronic: recurrent VTE, pulmonary hypertension, cor pulmonale |
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Term
|
Definition
Venography (invasive)
Ultrasonography (noninvasive)
D-Dimer |
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Term
|
Definition
Pulmonary angiography (invasive)
CT scan (non-invasive)
D-Dimer |
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Term
| Define hypercoaguable work up |
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Definition
A lab panel test for VTE in a patient who is < 40 yo and does not have any overt risk factors (i.e. idiopathic VTE)
Components:
a. Antiphospholipid antibodies
b. Factor V Leiden
c. Protein C
d. Protein S
e. Antithrombin III |
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Term
| List the etiology of cardioembolic stroke |
|
Definition
i. Atrial fibrillation (A.Fib.)
ii. Heart valve replacement
iii. Recent myocardial infarction
iv. Left ventricular mural thrombus
v. Left ventricular dysfunction |
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Term
| How is a cardioembolic stroke evaluated? |
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Definition
i. Brain imaging
ii. Cardiac evaluation: electrocardiogram and echocardiogram |
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Term
| List five different types of heart valves |
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Definition
Mechanical: caged-ball, single-tilting disk, bileaflet-tilting disk
Bioprosthetic: porcine, bovine |
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Term
| Which types of heart valve replacements are considered more thrombogenic? |
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Definition
Caged ball > Single-tilting disk > Bileaflet-tilting disk > Bioprosthetic
Multiple valves > Mitral valve > Aortic valve |
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Term
| Define a Activated Partial Thromboplastin Time (aPTT) test |
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Definition
Measures alterations in the intrinsic pathway of the clotting cascade and is used to monitor heparin therapy
However, highly variable by lab. An institution-specific range should be determined to correlate with heparin 0.2-0.4 U/mL |
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Term
| What does a Prothrombin Time (PT) test measure? |
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Definition
Extrinsic pathway of clotting cascade and is used to monitor warfarin therapy
Standardized with INR |
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Term
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Definition
| INR = [PTpatient/PTmean normal]ISI
Standardizes a PT test
Average normal INR=1, warfarin therapy goal INR=2-3 |
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Term
| What does an Anti-Xa Activity test measure? |
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Definition
Measures anti-Xa activity and may be used to monitor LMWH and fondaparinux therapy (when circumstances warrant)
However, expensive and limited availability |
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Term
| What does an Activating clotting time test measure? |
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Definition
| Measures activity of factors VII, VIII, IX, X, XI and provides a more accurate measurement when higher heparin doses are used. ACT is used primarily in setting of acute coronary syndrome (ACS) |
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