Makindo Medical Notes

Arterial thrombosis occurs when a blood clot forms in an artery, obstructing blood flow to critical organs and tissues. It is a serious condition that may lead to ischaemia, infarction, or stroke.

Common Causes

• Atherosclerosis: The most common cause. Plaque buildup leads to arterial narrowing and clot formation.
• Vascular Injury: Trauma or surgical procedures may cause thrombosis due to vessel damage.
• Hypercoagulable States: e.g. antiphospholipid syndrome, cancer, or genetic clotting disorders increase the risk.
• Emboli: Thromboembolism from the heart, as seen in atrial fibrillation or following myocardial infarction.

Clinical Presentation

• Acute Limb Ischemia: Sudden pain, pallor, paresthesia, pulselessness, and paralysis in affected limbs.
• Myocardial Infarction (MI): Chest pain, shortness of breath, and potential shock in severe cases.
• Ischaemic Stroke: Sudden onset of focal neurological deficits such as hemiparesis or aphasia.

Virchow's Triad describes the three primary factors that contribute to thrombus formation

Diagnostic Tests

• Doppler Ultrasound: Non-invasive method to detect blood flow obstruction in peripheral arteries.
• Angiography (CTA/MRA): Provides detailed images of arterial blockages.
• ECG and Echocardiogram: Assess cardiac function and identify sources of emboli in cases of cardiac-related thrombosis.
• Blood Tests: D-dimer, coagulation profile, and markers of inflammation (e.g., CRP) to evaluate clotting abnormalities.

Management

• Antiplatelet Therapy: Aspirin and clopidogrel are first-line treatments to prevent further thrombosis.
• Anticoagulation: Heparin or direct oral anticoagulants (DOACs) are used for embolic or high-risk cases.
• Thrombolysis: Tissue plasminogen activator (tPA) is administered for stroke or acute MI within the therapeutic window.
• Endovascular Procedures: Angioplasty, stenting, or thrombectomy may be needed to restore blood flow in severe cases.
• Surgical Intervention: In critical limb ischaemia, surgical bypass or embolectomy may be required to save the limb.

Note: Time is critical in managing arterial thrombosis, especially in cases of stroke, MI, or limb ischaemia. Early intervention improves outcomes significantly.

Prevention

• Lifestyle Modification: smoking cessation, healthy diet, regular exercise to reduce the risk of atherosclerosis.
• Management of Risk Factors: Control hypertension, diabetes, and hyperlipidemia aggressively.
• Long-term Antiplatelet Therapy: in case of arterial thrombosis, continued antiplatelet therapy may reduce recurrence risk.