Arterial thrombosis
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 Features
- 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
| Component of Virchow's Triad |
Description |
Relevance in Arterial Thrombosis |
| Endothelial Injury |
Damage to the inner lining of blood vessels, often due to trauma, surgery, or atherosclerosis. |
Most significant cause in arterial thrombosis. Plaque rupture or vascular injury often leads to clot formation. |
| Abnormal Blood Flow |
Turbulence or stasis of blood flow can contribute to clot formation. |
In arterial thrombosis, turbulence from atherosclerotic plaques disrupts normal laminar flow, increasing the risk of thrombus formation. |
| Hypercoagulability |
An increased tendency for blood to clot, which may be inherited or acquired (e.g., cancer, antiphospholipid syndrome). |
In arterial thrombosis, hypercoagulable states (e.g., thrombophilia, smoking, diabetes) accelerate clotting. |
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.
