Question 1 · structured
10 marksPart (a) Explain the role of platelets and thrombin in the blood clotting process. (4 marks) Part (b) A clinical trial investigated the effect of a new anticoagulant drug, Factor-X inhibitor. Explain how a drug that inhibits the coagulation cascade can reduce the risk of cardiovascular disease (CVD). (3 marks) Part (c) In a cohort study, the incidence of cardiovascular events was 84 per 1000 in the placebo group and 52 per 1000 in the drug-treated group. Calculate the percentage decrease in cardiovascular events for patients taking the drug. Show your working. (3 marks)
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Worked solution
Part (a) Platelets release thromboplastin in response to damage to blood vessel walls. Thromboplastin, along with calcium ions and clotting factors, catalyses the conversion of inactive prothrombin into the active enzyme thrombin. Thrombin then catalyses the conversion of soluble fibrinogen into insoluble fibrin. The fibrin fibres form a mesh that traps blood cells to form a clot. Part (b) Inhibiting the coagulation cascade prevents the production of thrombin, which in turn prevents the conversion of fibrinogen to fibrin. This reduces the formation of blood clots (thrombi) within blood vessels, such as coronary arteries. This maintains blood flow and oxygen supply to cardiac muscle, reducing the risk of myocardial infarction. Part (c) Decrease in events = \(84 - 52 = 32\). Percentage decrease = \((32 / 84) \times 100 = 38.1\%\) (or 38.09%).
Marking scheme
Part (a) [4 marks] 1. Platelets release thromboplastin (1 mark) 2. Thromboplastin converts prothrombin to thrombin (1 mark) 3. Calcium ions or clotting factors required (1 mark) 4. Thrombin converts soluble fibrinogen to insoluble fibrin (1 mark) Part (b) [3 marks] 1. Inhibitor prevents thrombin or fibrin formation (1 mark) 2. Reduces risk of blood vessel occlusion or thrombosis (1 mark) 3. Maintains blood flow or oxygen delivery to heart tissue (1 mark) Part (c) [3 marks] 1. Calculation of difference: 84 - 52 = 32 (1 mark) 2. Division by original value: 32 / 84 (1 mark) 3. Correct percentage with rounding: 38.1% or 38.09% (1 mark)