06 aula hemodinamicos 2
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Distúrbios Hemodinâmicos II - Trombose
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Endotélio
Plaquetas
Cascata da coagulação
Hemostasia / Trombose
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Papel do endotélio Hemostasia / Trombose
Efeitos anti-trombóticos
Antiplaquetários:Barreira anatômica para MECProstaciclina (PGI)Óxido nítricoAdenosina trifosfatase
Anticoagulantes:TrombomodulinaMoléculas semelhantes à heparina
Fibrinóliset-PA (ativador do plasminogênio tecidual)
Efeitos pró-trombóticos
Produção basal do fator de von WillebrandExpressão de fator tecidual (por TNF e IL-1)Inibidores dos ativadores do plasminogênio
Robbins 2005
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Papel do endotélio Hemostasia / Trombose
Robbins 2005
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Papel do endotélio Hemostasia / Trombose
Rubin 2006
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Papel do endotélio Hemostasia / Trombose
Inibição plaquetária
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Papel do endotélio Hemostasia / Trombose
Anticoagulação
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Papel do endotélio Hemostasia / Trombose
Robbins 2005
Fibrinólise
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Papel do endotélio como pró-trombótico Hemostasia / Trombose
Robbins 2005
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Papel do endotélio como pró-trombótico Hemostasia / Trombose
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Papel das plaquetas Hemostasia / Trombose
Grânulos PDGFTGF Fatores de coagulação
Grânulos ADP e ATPCálcioEpinefrina
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Papel das plaquetas Hemostasia / Trombose
AdesãoFator vW
SecreçãoCálcio (cofator da cascata de coagulação)ADP (estimulante da agregação plaquetária)Tromboxano A2
AgregaçãoContração plaquetáriaFusão (metamorfose viscosa)
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Papel da cascata de coagulação Hemostasia / Trombose
Vias de ativação- intrínseca (MEC)- extrínseca (fator tecidual)
TrombinaFibrinaPlasmina
Limitação do coágulo / trombo- antitrombinas- proteínas C e S (dependentes da Vit.K)- inibidor da via do fator tecidual
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Lesão endotelial
Alterações do fluxo sanguíneo
Estados de hipercoagulabilidade
Trombose: fatores
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Lesão endotelial
Lesão endotelial nos infartos miocárdicos (subendocárdica)
Trombose: fatores
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Lesão endotelial Ulceração endotelial nas placas de ateroma
Trombose: fatores
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Alterações do fluxo sanguíneo
Turbulência do fluxo arterial
Trombose: fatores
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Alterações do fluxo sanguíneo
Fibrilação atrial
Trombose: fatores
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Estase venosa
Imobilização
“doença da classe econômicadas viagens aéreas”
hiperviscosidade do sangue,
falcemia
Trombose: fatores
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Trombose venosa profunda
Trombose venosa
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Trombose: fatores
Hipercoagulabilidade
Fatores genéticos- polimorfismo do gene da protrombina
Fatores adquiridos- hiperestrogenismo (gestação, contraceptivos orais)- obesidade- tabagismo- idade- neoplasias avançadas- anticorpos antiplaquetas por terapia com heparina- síndrome do anticorpo antifosfolipídio
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gestação sepse
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Coagulação intravascular disseminada
↓ Plaquetas
↓ Fibrinogênio
↑ Produtos de fibrinólise
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Efeitos da trombose
Trombos arteriais e intracardíacos- trombos murais - ateroesclerosetromboembolia sistêmica
Trombos venosos-trombose venosa de MMIItromboembolia pulmonar
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Tromboembolia arterial (sistêmica)
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Tromboembolia venosa (pulmonar)
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Tromboembolia venosa (pulmonar)
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Propagação
Embolização
Dissolução
Organização e recanalização
Destinos de trombo
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Trombose venosa (hemorróidas)
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Trombose venosa (hemorróidas)
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Trombose venosa (hemorróidas)
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Trombose venosa (hemorróidas)
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Obstrução arterial
Obstrução venosa
Efeitos locais da trombose
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Trombose arterial
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Infarto branco (isquêmico)
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Trombose venosa (infarto hemorrágico)
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Infarto vermelho (circulação rica em comunicações)
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Infarto vermelho (dupla circulação verdadeira)
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Infarto vermelho (dupla circulação verdadeira)
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Infarto vermelho (torção de pedículos vasculares)