Understanding Thrombosis and Thromboembolism
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ScribdTranslationsUnderstanding Thrombosis and Thromboembolism
Translated by
ScribdTranslationsTHROMBOSIS
It is an imbalance between procoagulant and anticoagulant factors.
• Thrombus: it is a clot on the walls of blood vessels.
• Embolus: fragment of a clot that travels to the distal end of a vessel
sanguine
Virchow's triad: 3 conditions for a clot to form, in our environment the
Atherosclerosis is the most common vascular lesion.
There are differences when a clot is of venous and arterial origin.
Arterial Venous
>65 mmHg PVM: 10 mmHg
For a clot to obstruct the lumen, the pressure is much lower, the flow
It is necessary for the vase to grow from the bottom towards the sanguine; it is slower, which allows for.
above and must overcome the speed of the clot formed at the expense of fibrin
flow, however, having a flow that traps red blood cells and is RED
high sanguine displaces the factors of
coagulation and the clot form at
expenses of the plates and isWHITE
Antiplatelet agents like ASS are given because arterial clots are made up of platelets.
which anticoagulants will not work, however, in venous clots the patient
benefits of anticoagulants.
Kerolyne Loayza Pinzón
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THROMBOEMBOLISM
It is characterized by the formation of thrombi usually in the venous circulation that
It can be superficial (less serious) and deep.
• TEP is 10% fatal.
• More common in men
• Aged over 55 years, especially women entering menopause.
Post-thrombotic syndrome: half of the patients (50%) after a thrombotic event
they are left with pain, edema, and ulcers in the area of the injury.
Deep vein thrombosis
In 40-50% of those who present with DVT, the thrombus may migrate to the circulation.
pulmonary and cause a PE with a mortality rate of 10%.
Pathophysiology
In the venous circulation are
presents the valves that are used for
maintain and ensure the flow
sanguineous that prevent the blood
he returns by gravity, without
embargo, at the level of the valve it
produce a bag that at its vertices
there is less blood flow and less
amount of oxygen that predisposes
an endothelial injury but the endothelium
Are you prepared for this situation?
with anticoagulant factors such as the
heparin oxide nitric TPA,
prostacyclin, antithrombin, CD39.
When the person is standing, a person who has obesity, who has an increase
the abdominal mass prevents proper blood flow and a process occurs
venous stasis, that is, blood accumulates in the valve and the veins dilate (varices) and
the valve opens and allows the return of blood leading to greater stasis and more
hypoxia, causing the endothelial factors to be depleted (endothelial dysfunction)
triggering an inflammatory process through the activation of leukocytes, tissue factor and
of neutrophils and platelets favoring the state of hypercoagulability that finally
it will end up producing deep vein thrombosis.
Kerolyne Loayza Pinzón
Clinic
The most common site of presentation is the calf
• 20% is in proximal veins (popliteal)
• Emboli are more likely in proximal veins at the thigh level.
Features
• Unilateral edema
• Pain
• Red and dark skin
• Collateral venous return: due to the obstruction of the
main vein
PE (pulmonary embolism)
• 40% as a result of an episode of DVT
• They may not show symptoms of DVT.
• Presents with: chest pain, dyspnea, and tachycardia
Diagnosis
Deep vein thrombosis Pulmonary embolism
Kerolyne Loayza Pinzón
Diagnostic algorithm
NOTE: D-dimer indicates that there was a clot, measures fibrinolysis, has high sensitivity.
so if it comes out normal I discard it, but it has low specificity.
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THROMBOPHILIAS
It is a latent possibility of forming arterial or venous thrombi and there are several causes.
as:
Hereditary alterations Acquired alterations
• Factor V (5) Leiden • Surgery
• G20210A mutation of prothrombin • Pregnancy
• MTHFR mutation - hyperhomocysteinemia • Oral contraceptives
Coagulation system disorders
• Increase of factor VIII
• Antithrombin deficiency
Secondary thrombophilia
• APS (antiphospholipid syndrome)
• Traumas
• Disseminated intravascular coagulation (DIC)
• Cancer
• Atherosclerosis
Treatment
They are treated with anticoagulants, which are divided into two groups:
Kerolyne Loayza Pinzón
Traditional
Warfarin: vitamin K antagonist
that acts on factor 2, 7, 9, 10
Unfractionated heparin and heparin of
low molecular weight: they act on the
thrombin which is factor 2 and about it
factor 10.
New
Rivaroxaban, apixaban and endoxaban: are
factor 10 inhibitors
Dabigatran: inhibits thrombin (factor II)