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do any of the inherited thrombotic disorders lead to arterial thromboses?
which 2 inherited clotting disorders increase VTE?
- Homozygous factor V leiden
- antithrombin deficiency
do you treat inherited thrombotic disorders?
- no unless:
- preg -> heparin
- active thrombus -> LMWH and warfarin
what is coumarin?
what is the prognosis of homozygous antithrombin deficiency?
death in utero
genetics of antithrombin deficiency?
people with antithrombin deficiency get a VTE before the age of what?
how much does the risk of thrombosis increase in antithrombin deficiency?
when do you treat, and with what, antithrombin deficiency?
- if preg -> LMWH
- if heart surg using cardiopulmonary bypass -> antithrombin transfusion pre-op
what does antithrombin do?
- inactivates activated factors
- -> hinders thrombosis
how do heparin and fondaparinux work?
what do deficiencies in protein C or protein S do?
- -> prothrombotic state
- X5 risk of thrombosis
talk about protein C/S?
dependent on which vit
role in coag
- need vit K for synthesis
- they are natural anticoagulants by:
- -reducing thrombin generation
- -deactivating factors
what percentage of the following have factor V leiden:
what is the genetic change in factor V leiden?
- gain of function mutation
- stops cleavage and thus inactivation of factor Va
what is the risk increase of thrombosis in factor V leiden?
X50 in rare heterozygotes
what is APS?
what is the cause of APS?
antiphospholipid antibodies vs the attached proteins
what tests are used to diagnose APS?
- ELISA for the autoAb
- DRVVT (?lupus anticoagulant)
what two autoAbs do you search for with ELISA testing in APS?
- anticardiolipin Ab
- anti-beta2 glycoprotein I Ab
what complication of preg is assoc with APS?
name a non-inherited cause of increased risk of VTE and arterial thrombi?
complications of APS?
- VTE and art thrombosis
- pre eclampsia
- livedo reticularis
- transverse myelitis
- skin necrosis
normally if someone has a Hx of stroke they are put on aspirin, what do you give them if they have APS?
APS is linked to what autoimmune conditions?
- systemic sclerosis
- temporal arteritis
what is sjogren's?
autoimmune attack of exocrine glands
what is the DRVVT used in testing for lupus anticoagulant for APS?
Dilute russell viper venom test
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