T/F: Primary hemostasis is the coagulation activation
False; coagulation activation is the secondary hemostasis
Coagulation activation (secondary hemostasis) begins with ____ activation, followed by the amplification phase which involves _______, _____, _____ and then the propagation phase which is aka ____ that finally leads to ____formation and a definitive hemostatic plug
Platelets, V , VIII
What is the virchow’s triad:
What can indicate inherited thrombophilia?
Less than 50 years of age
First degree relative with blood clots
Recurrent thrombotic episodes
Odd location of clots
For inherited thrombophilia, deficiencies for which factor/ protein could be the cause?
Factor V Leiden (6% white people)
Prothrombin G2021A (3% white people)
Protein C deficiency
Protein S deficiency
History of past surgery/ trauma, long plane rides, cancer and medication such as OCP use is indicative for which type of thrombophilia?
Recent trauma or surgery suggest _____ thrombophilia due to ______
Acquired thrombophilia due to vascular injury
Long plane, train, bus or car ride suggest ____ thrombophilia due to _____
Cancer can be indicative of ____ thrombophilia due to ___
Medications such as oral contraceptive can be suggestive of _____ thromnophilia due to _____
Non-iatrogenic acquired thrombophilia consists of ___ vs _____. While iatrogenic acquired thrombophilia consists of _____ vs ______
Surgery, especially of orth or pelvic nature, along with forced immobility are _____ cause of acquired iatrogenic thrombophilia
oral contraceptive, self-medication, EPO use and hormone replacement therapy are ____ Cause of acquired iatrogenic thrombophilia
cancer is considered as _____ acquired thrombophilia
T/F: patient with cancer often have DVT that they don’t even know of
True; malignancy would be an non-iatrogenic acquired thrombophilia
What are non-malignant non-iatrogenic etiologies of thrombophilia
Antiphospholipid antibody syndrome
Polycythemia rubra very
Which imaging workup is useful in accessing a possible lower extremity DVT?
Venous compression US
An echogenic thrombus on venous US will be found in a ________ venous lumen
T/F: D-dimers are sensitive and specific for intravascular thrombosis
False; they are sensitive but not specific, so a negative assay may be helpful in ruling out a DVT but a positive test does NOT indicate that the patient HAS a clot
A negative D-dimer _____ clot. A positive D-dimer _____ clot
Can rule out
cannot be indicative of a (though have suspicions)
What is the next step when D-dimer comes back positive?
Use CT-angio with IV contrast to evaluate for possible Pulmonary embolus. Because a positive does not indicate that there IS a blood clot
Wells criteria for DVT, most finding is worth ______ point(s). What is special about this one?
Each finding is worth 1 point
However, an alternative explanation for leg symptoms such as due to infections or cellulitis, you TAKE AWAY 2 points
If 0-1 point on DVT Well’s criteria, it is _______, so you would do. While >1 point is _______, and you would ______.
0-1 point, DVT is unlikely, and you would just check D-dimer to rule out DVT
1+ points, DVT is likely so order a Doppler ultrasound to evaluate for DVT
T/F: if you have more than one points on the Well’s criteria for DVT, you would go ahead and order a D-dimer to rule out a DVT
False; if you have more than one point, then you would skip D-dimer and get a doppler ultrasound to evaluate for DVT. You would only order D-dimer when it is 0 to 1 point.
How is Well’s criteria for PE scored? ______ gets 3 points, ________ gets 1.5 points and ______ get 1 point
Clinical signs and sxs of DVT / PE is the most likely diagnosis : each get 3 points
Bedridden for > 3 days / History of DVT or PE gets: 1.5 points each
Hemoptysis / active cancer: gets 1 point each
Scores of Well’s criteria for PE:
Less than 4 points = unlike PE, check D-dimer
4-6 points = moderate possibility of PE – do CTA to assess for PE
Greater than 6 points = high probability of PE – do CTA to assess
After a clot has resolved, what are some serologic markers that you would want to check?