Pathophysiology of Clotting (L23)

hemostasis (making blood stay in place) can be done via __________, ___________, or ______________

vasoconstricting, plugging, coagulating

platelet ___________ happens when vascular injury causes the release of clotting factors (collagen, thrombin, PAF, TXA₂), then those factors tell platelets to adhere to subendothelium of the vessel and become activated (which releases stuff to enhance activation of nearby platelets) then these ___________ and form a ________

aggregation, aggregate, plug

platelet aggregation happens when vascular injury causes the release of _____________, then those tell platelets to adhere to subendothelium of the vessel and become activated (which releases stuff to enhance activation of nearby platelets) then these aggregate and form a plug

clotting factors (collagen, thrombin, PAF, TXA₂)

platelet aggregation happens when vascular injury causes the release of clotting factors, then those factors tell platelets to __________ to subendothelium of the vessel and become ___________ (which releases stuff to enhance activation of nearby platelets) then these aggregate and form a plug

adhere, activated

platelet aggregation happens when vascular injury causes the release of clotting factors, then those factors tell platelets to adhere to subendothelium of the ___________ and become activated (which releases stuff to enhance activation of nearby platelets) then these aggregate and form a plug

vessel

_____________ is when an injured blood vessel exposes tissue factors to initiate the _____________ system via Thrombin IIa which is responsible for converting fibrinogen into fibrin, which anchors the aggregate to the vessel walls

coagulation

coagulation is when an injured blood vessel exposes _________________ to initiate the coagulation system via Thrombin IIa which is responsible for converting fibrinogen into fibrin, which anchors the aggregate to the vessel walls

tissue factors

coagulation is when an injured blood vessel exposes tissue factors to initiate the coagulation system via __________________ which is responsible for converting fibrinogen into fibrin, which anchors the aggregate to the vessel walls

Thrombin IIa

coagulation is when an injured blood vessel exposes tissue factors to initiate the coagulation system via Thrombin IIa which is responsible for converting __________ into _______, which anchors the aggregate to the vessel walls

fibrinogen, fibrin

coagulation is when an injured blood vessel exposes tissue factors to initiate the coagulation system via Thrombin IIa which is responsible for converting fibrinogen into fibrin, which anchors the _________ to the vessel walls

aggregate

normal blood coagulation is the sequential activation of _____ factors, with the end result being _________ formation

12, fibrin

clotting factors are synthesized in ________ and then circulate in the blood in the ____________ state

liver, inactive

clotting factors are synthesized in liver and then circulate in the blood in the inactive state

then they are activated into _________ activation factors, or _______-dependent factors, or _________-sensitive factors

contact, vitamin-K, thrombin

the body’s natural means of anticoagulation is via ______________ which activates IIa, IXa, Xa, XIa, and XIIa

antithrombin

the body’s natural means of anticoagulation is via antithrombin which activates IIa, IXa, Xa, XIa, and XIIa

if this is defective (usually d/t a mutation in factor _____), there is an increased risk of ______________

V, thrombosis (clot)

other than antithrombin ofc, another means of natural anticoagulation is through _______ and _______ which cause vasodilation to try and inhibit activation an aggregation of platelets

NO, PGI2

other than antithrombin ofc, another means of natural anticoagulation is through NO and PGI₂ which cause _____________ to try and inhibit activation an aggregation of platelets

vasodilation

___________, also called a ______, is inappropriate fibrin-platelet aggregate in the blood or lymph in the heart (cardiac) or free in the lumen (thromboemolus)

thrombosis, clot

thrombosis, also called a clot, is inappropriate ________-_________ aggregate in the blood or lymph in the heart (cardiac) or free in the lumen (thromboemolus)

fibrin, platelet

VTE, Venous ThromboEmbolism, is a clot in the venous system that can go to the _________ or __________

deep veins (DVT) or lungs (PE)

VTE, Venous ThromboEmbolism, is a clot in the ____________ system that can go to the lungs (_____) or deep veins (____)

venous, PE, DVT

ischemic stroke risk: stroke is a thrombus/clot that is formed in the _________ and then travels to the ___________

left atria, brain (afib is a risk factor; more blood pools in the heart= more potential to clot)

post-thrombotic syndrome (PTS) is signs and symptoms of chronic venous insufficiency due to _________________

DVT (pain, aching, swelling leg, heavy, itchy, tingling, cramping leg, sore/ulcer on leg)

____________________ is signs and symptoms of chronic venous insufficiency due to a DVT like pain, aching, swelling of the leg, heavy itchy, tingling, cramping leg, sore/ulcer on the leg

Post-Thrombotic Syndrome (PTS)

signs and symptoms of DVT are non-specific (best to look at pts PMH), but can include ____________, __________, tenderness, and _________

swelling, redness, edema

diagnosis of a DVT is done first with the _____________ scoring for DVT

Wells pretest probability

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is _______, there is a high probability of forming a DVT and the patient should get an ultrasound

>2

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is >2, there is a high probability of forming a DVT and the patient should _______________

get an ultrasound (if its positive= DVT) (if its negative= no DVT)

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is <2, there is a moderate probability of forming a DVT and the patient should _______________

get a D-dimer test

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is _____, there is a moderate probability of forming a DVT and the patient should get a D-dimer test

<2

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is <2, there is a moderate probability of forming a DVT and the patient should D-dimer test

if the D-dimer is __________= No DVT

<500 (a negative D-dimer is definitely indicative of there not being a DVT; while a positive D-dimer is not 100% indicative that there is a clot)

(D-dimer is a product of the breakdown of fibrin; so if it doesn’t show up, there is no fibrin clots at the moment)

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is <2, there is a moderate probability of forming a DVT and the patient should D-dimer test

if the D-dimer is <500 =__________

No DVT (a negative D-dimer is definitely indicative of there not being a DVT; while a positive D-dimer is not 100% indicative that there is a clot)

(D-dimer is a product of the breakdown of fibrin; so if it doesn’t show up, there is no fibrin clots at the moment)

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is <2, there is a moderate probability of forming a DVT and the patient should D-dimer test

if the D-dimer is __________= DVT present

>500 (kindaaaaa; a positive D-dimer is not 100% indicative that there is a clot… a negative D-dimer is more indicative of there not being a DVT)

(D-dimer is a product of the breakdown of fibrin; so if it shows up, there is a fibrin clot somewhere)

diagnosis of a DVT is done first with the Wells pretest probability scoring for DVT

if the Wells score is <2, there is a moderate probability of forming a DVT and the patient should D-dimer test

if the D-dimer is >500 =________

DVT (kindaaaaa; a positive D-dimer is not 100% indicative that there is a clot… a negative D-dimer is more indicative of there not being a DVT)

(D-dimer is a product of the breakdown of fibrin; so if it shows up, there is a fibrin clot somewhere)

VTE risk factors are the ________ triad

1. Blood stasis 2. Vascular injury 3. Hypercoagulable state

Virchow’s

_______ risk factors are the Virchow’s triad

1. Blood stasis 2. Vascular injury 3. Hypercoagulable state

VTE

VTE risk factors are the Virchow’s triad

1. __________ 2. ____________ 3. ____________

blood stasis, vascular injury, hypercoagulable state

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Blood stasis: blood sitting with a patient who is not getting up and moving around enough due to ______________

prolonged immobility (maybe from an injury or after a surgery)

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Vascular injury: trauma, surgery, heart valve replaced, vascular catheters, atherosclerosis

pts having ____________ or __________ surgery are at the highest risk

THA or TKA (total hip or knee arthroplasty)

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Vascular injury: trauma, surgery, heart valve replaced, vascular catheters, atherosclerosis

the highest risk for surgical patients is at _________ post-op

7 days

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Vascular injury: trauma, surgery, heart valve replaced, vascular catheters, atherosclerosis

the __________ score can be used to assess hospitalized medically ill patients

Padua

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Vascular injury: trauma, surgery, heart valve replaced, vascular catheters, atherosclerosis

the Padua score can be used to assess hospitalized _______________ patients

medically ill

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Vascular injury: trauma, surgery, heart valve replaced, vascular catheters, atherosclerosis

the Padua score can be used to assess hospitalized medically ill patients

if it is <____, the patient is at low risk for VTE and if it is >____ they are at high risk

4 (based on age, cancer, PMH, obesity, etc.)

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Hypercoagulable state: malignancy, factor _____ mutation, APLS, __________ and __________-containing ______

V, pregnancy, estrogen OCPs

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

_______________: malignancy, factor V mutation, APLS, pregnancy and estrogen-containing OCPs

hypercoagulable state

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Hypercoagulable state: malignancy, factor V mutation, APLS, pregnancy and estrogen-containing OCPs

pts with ________ or ________ are a 5x higher risk for VTE

cancer or pregnancy

VTE risk factors are the Virchow’s triad (blood stasis, vascular injury, hypercoagulable state)

Hypercoagulable state: malignancy, factor V mutation, APLS, pregnancy and estrogen-containing OCPs

VTE risk is highest ________ post-partum

6 weeks

signs and symptoms of PE are non-specific but similar to the signs and symptoms of a __________

MI (chest pain, dyspnea, tachycardia, sweaty, faint)

signs and symptoms of ____________ are non-specific but similar to the signs and symptoms of an MI (chest pain, dyspnea, tachycardia, sweaty, faint)

PE

diagnosis of PE is done with the _________-PE score

Wells

diagnosis of PE is done with the Wells-PE score

if the Wells score is _______, a PE is likely and the patient should have CTPA imaging

>4

diagnosis of PE is done with the Wells-PE score

if the Wells score is >4, a PE is likely and the patient should ______________

have CPTA imaging

diagnosis of PE is done with the Wells-PE score

if the Wells score is >4, a PE is likely and the patient should have CTPA imaging

if the CPTA imaging is positive= ______________ and the patient should ____________

PE present, get anticoagulation!

diagnosis of PE is done with the Wells-PE score

if the Wells score is >4, a PE is likely and the patient should have CTPA imaging

if the CPTA imaging is negative= ______________

No PE

diagnosis of PE is done with the Wells-PE score

if the Wells score is _______, a PE is less likely and the patient should get a D-dimer test

<4

diagnosis of PE is done with the Wells-PE score

if the Wells score is <4, a PE is less likely and the patient should ______________

get a D-dimer test

diagnosis of PE is done with the Wells-PE score

if the Wells score is <4, a PE is less likely and the patient should get a D-dimer test

if the D-dimer test is positive (>500)= _______________ and the patient should _______________

PE likely, get CPTA imaging

diagnosis of PE is done with the Wells-PE score

if the Wells score is <4, a PE is less likely and the patient should get a D-dimer test

if the D-dimer test is negative (<500)= ___________

No PE

the ____________ is what guides a clinician on if a patient with a PE can go home or not

PESI (Pulmonary Embolism Severity Index)