Term
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Definition
o Venous Stasis – slowed rate of blood flow; through immobility or compression
o Vascular Injury – involves damage to vasculature favoring deposition of platelets/fibrin
o Hypercoagulability – blood components are in favor of thrombosis to begin with |
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Term
| why do we give heparin initially when starting warfarin in protein S deficient px? |
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Definition
| Factors VII and X wane with warfarin therapy. You have tipped in favor however of coagulation during the first bit, X is still active |
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Term
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Definition
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Term
| Protein C Def - prev, congenital?, warfarin effects? |
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Definition
o Prevalence – present in 1 in 200-500 individuals, 2-9% of individuals w/ venous thrombosis
o Vs. Acquired – many diseases lead to acquired Protein C deficiency, so be wary of Dx congen.
o Homozygous deficiency – neonatal purpura fulminans
o Warfarin (Coumadin) – will lower protein C levels, so can’t Dx when on these drugs
Warfarin hypercoagulability – warfarin dec. protein C faster than coagulants initially! |
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Term
| what lowers protein S levels and thus confounds diagnosis of PSD? |
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Definition
| o Oral contraceptives, pregnancy |
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Term
| what lowers ATIII levels and thus confounds diagnosis of ATIIIDef? |
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Definition
| chronic heparin therapy, or acute thrombosis |
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Term
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Definition
| o aPTT test – heparin won’t prolong, since ATIII isn’t really there! Often how Dx is made… |
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Term
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Definition
o Action – binds & inhibits thrombin & Xa, along with IXa, XIa, XIIa
o Severity – much more severe than protein C/S deficiencies; causes very early thromboses (teen) |
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Term
| Review the Lecture Chart! |
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Definition
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Term
| Pro-Coagulant Thrombophilias: name 6 |
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Definition
| Factor V leiden, prothrombin 20210 mutation, fibrinolysis abnormality, hyperhomocysteinemia, dysfibrinogens, excessive clotting factor |
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Term
| Factor V Leiden - mech, prevalence, thrombosis risk, contraceptives, effect of blood types/weight! |
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Definition
mutation in Factor V leading to resistance to protein C hypercoagulability
o Protein C Resistance – protein C can no longer deactivate mutated factor V
o Prevalence – only Caucasians
o Thrombosis – 7x increase in risk with heterozygous mutation
o Oral contraceptives – will magnify thrombosis risk
o Some people will not have problems…O blood type matters – gives you less risk! 3X vs. 25.2! + weight => more risk! Metabolic syndrome! |
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Term
| prothrombin 20210 mut - mech, prevalence |
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Definition
excessive prothrombin synthesis
o Thrombosis – also increased risk
o Prevalence – also only in Caucasians (some SE Asians too, likely result of trade routes) |
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Term
| • Fibrinolysis Abnormality mech |
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Definition
| – decreased levels of plasminogen or elevated plasminogen inhibitor (PAI-1) |
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Term
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Definition
associated with premature atherosclerosis, venous thromboembolism
o Oxidative damage – elevated levels of homocysteine lead to vascular damage thrombosis
o CAD – greater risk of CAD due to accelerated atherosclerosis
o Methylene Tetrahydrofolate Reductase – elevated MTHFR leads to elevated homocysteine |
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Term
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Definition
| fibrinogens polymerize too easily, or which lack cleavage sites thombosis |
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Term
| Excessive Clotting Factor |
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Definition
| most commonly too much Factor VIII hypercoagulability |
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Term
| Tx for thrombophilic disorders |
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Definition
| anticoag, lytic therapy, embolectomy, stenting, protein C concentrates, antithrombin III concentrates |
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Term
| arterial vs. venous thrombus |
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Definition
• Arterial Thrombosis – atherosclerotic plaques, a “white thrombus”
o Elevated – lipoproteins, factor VII, homocysteine, platelets, GpIIbIIIa gain-of-function
• Venous Thrombosis – a “red thrombus” |
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Term
| Lipoprotein (a) - what is it?, structure and function, role of ICAM-1, associated with ____ in men |
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Definition
• Lp(a) – modified LDL, serum levels are genetically determined
• Structure – homologous to plasminogen interfere w/ fibrinolysis and interacts with macrophages to promote foam cell formation and deposition of cholesterol
• ICAM-1 – enhanced expression leading to recruitment and binding of monocytes to vessel wall
• Levels – associated w/ cerebrovascular disease in men |
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