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pre reg afsha > VTE > Flashcards

VTE Flashcards

1
Q

what is VTE

A
  • blot clot forms in vein which partially or completely obstructs blood flow
  • includes DVT and PE
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2
Q

What is hospital acquired VTE

A

VTE occurs within 90 days of hospital admission

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3
Q

risk factors for VTE

A
  • surgery
  • trauma
  • significant immobility
  • malignancy
  • obesity
  • acquired or inherited hypercoaguable states
  • pregnant
  • postpartum
  • hormonal therapy - HRT or COC
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4
Q

most common form of VTE

A

DVT

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5
Q

DVT usually occurs in the following two areas ….. but can also affect other sites

A

deep veins of legs or pelvis

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6
Q

symptoms of DVT

A
  • unilateral localised pain
  • swelling
  • tenderness
  • skin changes
  • vein distention (swollen)
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7
Q

what is pulmonary embolism and how does it happen

A

commonly occurs when a thrombus, usually from a DVT, travels in blood (embolus) and obstructs blood flow to lungs causing respiratory dysfunction

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8
Q

symptoms of PE

A
  • chest pain
  • SOB
  • haemoptysis
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9
Q

what tool is used if DVT suspected

A

2-level DVT Wells Score is used to estimate clinical probability of DVT

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10
Q

When would the Wells score indicate DVT is likely

A

DVT likely if 2 points or more

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11
Q

When would the Wells score indicate that DVT is not likely

A

Wells score 1 point or less = DVT not likely

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12
Q

What is D dimer and what is the test

A
  • D dimer is a protein fragment that is made when a blood clot dissolves in the body
  • High D dimer test = may have a blood clot
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13
Q

risk of VTE on admission to hospital

A

all pt to undergo risk assessment to identify their risk of VTE and bleeding on admission

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14
Q

what are the two methods of thromboprophylaxis

A

mechanical
pharmacological

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15
Q

mechanical thromboprophylaxis - what is it and who would you offer it to

A
  • anti-embolism stockings that provide graduated compression and provide calf pressure of 14-15mmHg, and intermittent pneumatic compression
  • should be worn day and night until pt is sufficiently mobile
  • do not offer to pt admitted with acute stroke, or if they have conditions e.g. PAD, peripheral neuropathy, severe leg oedema or local conditions (e.g. gangrene, dermatitis)
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16
Q

pharmacological prophylaxis
- when is it used in most cases
- when to give in pt who are at high risk of bleeding
- considerations for people receiving AC treatment

A
  • when using, in most cases, stat ASAP or within 14h admission
  • pt with RF for bleeding should only receive when their risk of VTE outweighs risk of bleeding (e.g. acute stroke, thrombocytopenia, acquired or untreated inherited bleeding disorders)
  • pt receiving AC treatment who are high risk VTE should be considered for prophylaxis if AC treatment interrupted (e.g. during peri-op period)
17
Q

which anaesthesia should be used to reduce risk of VTE in surgical patients?

A

regional over GA if possible

18
Q

which type of prophylaxis should be offered to pt with major trauma or undergoing cranial, abdominal, bariatric, thoracic, maxillofacial, ENT, cardiac or elective spinal surgery?

A
  • mechanical prophylaxis
  • e.g. anti-embolism stockings or intermittent pneumatic compression
  • choice of which depends on factors e.g. type of surgery, suitability for pt, their condition
  • continue prophylaxis until pt sufficiently mobile or discharged from hospital, or for for 30 days in spinal injury, elective spinal surgery or cranial surgery
19
Q

which type of prophylaxis should be considered for pt undergoing general or orthopaedic surgery when risk of VTE outweighs bleeding risk?

A
  • pharmacological
  • choice depends on type of surgery’s suitability for pt, local policies
  • LMWH suitable in ALL types of general and orthopaedic surgery
  • unfractionated heparin preferred in pt with RI
20
Q

…… is an option for pt undergoing abdominal, bariatric, thorax or cadmic surgery, or for pt with lower limb immobilisation or fragility fractures of pelvis, hip or proximal femur

A
  • fondaparinux sodium
21
Q

which drug is preferred for pharmacological prophylaxis in pt with RI

A

unfractionated heparin

22
Q

pharmacological prophylaxis in general surgery should usually continue for…

A

at least 7 days post op or until sufficiently mobile

23
Q

how long should a pt receive pharmacological prophylaxis if they have had major cancer surgery in abdomen

A

28 days

24
Q

how long should a pt receive pharmacological prophylaxis in pt who have had spinal surgery

A

30 days

25
Q

when should mechanical prophylaxis with intermittent pneumatic compression be considered?

A
  • when pharmacological prophylaxis is contraindicated in pt undergoing lower limb amputation, or those with major trauma or fragility fractures of pelvis, hip or proximal femur
26
Q

pt undergoing elective hip replacement should be given thrombopropjhylaxis with
- 3 main options
- 3 alternatives

A
  • either LMWH for 10 days, followed by low dose aspirin for a further 28 days
  • or LMWH for 28 days in combo with anti-embolism stockings until discharged,
  • or rivaroxaban
  • alternatives: apixaban or dabigatran
  • alternative is pharmacological prophylaxis contraindicated: intermittent pneumatic compression until pt is mobile
27
Q

rivaroxaban dose for prophylaxis of VTE following hip or kneee replacement therapy

A
  • knee: 10mg OD for 2 weeks, to be stated 6-10h after surgery
  • hip: 10mg OD for 5 weeks to be started 6-10h after surgery
28
Q

acutely ill medical patients who are at high risk of VTE should be offered which type of prophylaxis? and what is first line treatment? what is treatment in pt with RI?

A

pharmacological
- 1st line: either LMWH or fondaparinux (alt) for minimum 7 days
- RI: either LMWH or unfractionated heparin, adjust dose as necessary

29
Q

acutely ill medical patients who are at high risk of VTE should be offered pharmacological prophylaxis. but if this is contraindicated, what should you do

A

consider mechanical prophylaxis and continue use until pt sufficiently mobile

30
Q

prophylaxis for pt admitted with acute stroke. how long should it be continued for. what is unsuitable

A
  • mechanical prophylaxis with intermittent pneumatic compression
  • anti-embolism stockings unsuitable!!
  • start within 3 days of acute stroke and continue for 30 days, or until sufficiently mobile, or discharged
31
Q

what is unsuitable in acute stroke

A

anti embolism stockings

32
Q

thromboprophylaxis in pregnancy - who should be considered for pharmacological prophylaxis with LMWH during hospital admission

A
  • all pregnant women (not in active labour), or women who have given birth, had a miscarriage or termination of pregnancy during the past 6 weeks, with a risk of VTE that outweighs the bleeding risk
33
Q

in pregnant women, prophylaxis should be continued until…

A
  • no longer a risk of VTE or until discharge from hospital
34
Q

women who have given birth, has a miscarriage or termination during the past 6 weeks, should start thromboporphylaxis with…. for how long?

A

with LMWH 4-8h after the event (unless contraindicated) for a minimum of 7 days

35
Q

pregnancy: additional mechanical prophylaxis (state which one is first line) should be considered for women who are likely to be immobilised or have significantly reduced mobility and should be continued until ….

A
  • continue until the woman is sufficiently mobile or discharged from hospital
  • 1st line: intermittent pneumatic compression, alt is anti embolism stocking
36
Q

what to do if someone has suspected PE and signs of haemodynamic instability, also state some signs of haemodyanmic instability

A
  • immediately refer for hospital admission
  • signs of haemodynamic instability include pallor, tachycardia, hypotension, shock, collapse
37
Q

non drug treatment for VTE treatment

A
  • elasticated graduation compression stockings may be used to manage leg symptoms after DVT
  • they are not recommended to prevent post-thrombotic syndrome or VTE recurrence after a DVT
  • mechanical interventions (e.g. inferior vena coal filters or percutaneous mechanism thrombectomy) can be considered in certain pt

pre reg afsha (60 decks)

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