Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 18. Hematologic and Oncologic Emergencies >|
Chapter 229. Clotting Disorders
Sections: Clotting Disorders: Introduction, Clinically Relevant Pathophysiology, Principles of Evaluation, Diagnosis and Treatment, Disposition and Follow-Up, Specific Conditions Associated with Thrombophilia, References.
Topics Discussed: coagulation disorders; thromboembolism; thrombosis.
Excerpt:"Understanding of the pathophysiology of thrombosis, both venous
and arterial, has increased dramatically over the past 50 years.
A rapidly increasing number of inherited and acquired conditions
predisposing patients to venous thromboembolism and/or
arterial thrombosis or embolus are being discovered. Virchow's
triad of hypercoagulability, venous stasis, and endothelial injury
continues to be a useful model for the interplay of genetic factors
and environmental triggers leading to inappropriate thrombosis.
Most patients develop venous thromboembolism after some inciting
event, such as trauma, surgery, or prolonged immobilization. However,
a patient with a disorder causing hypercoagulability can develop
a serious thrombotic event with little or no inciting factor. This
has led some researchers to postulate that risk from various factors
is additive; and when a patient's risk reaches a "thrombosis threshold," inappropriate
thrombus develops. In fact, some researchers believe that all patients
with thrombosis have a hypercoagulable tendency that is yet to be discovered. The initial
ED approach is similar for most common inherited and acquired conditions causing
hypercoagulable states (Table 229-1)...."
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