48 - Venous Thromboembolism Flashcards Preview

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Flashcards in 48 - Venous Thromboembolism Deck (29):
1

Initial recommendations for DVT?

-rest if symptoms warrant (reduces pain and swelling) but early walking is safe and may be preferred as resolution of pain and swelling may be faster
-elevate swollen limb while resting may increase resolution of edema
-start w acetaminophen (don't increase bleed risk)
-opioids may be required short-term

2

Initial recommendations for PE?

-oxygen for hypoxia
-IV fluids if hypotensive or volume contracted
-vasopressors for hypotension or shock
-start w acetaminophen (don't increase bleed risk)
-opioids may be required short-term

3

What is PTS (post-thrombotic syndrome)?

chronic swelling and pain, discomfort when walking, and skin discoloration

4

How do compression stockings help with PTS?

do not prevent PTS but they can improve edema and pain in the acute stage of DVT and can relieve pain of PTS

5

What is 1st line for established DVT or PE?

LMWH, UH, or fondaparinux

6

What needs to be used with your 1st line agents (LMWH, UH, or fondaparinux) in the beginning?

-oral vitamin K antagonists such as warfarin needs to be started at the same time and administered concurrently for several days

-Give your 1st line agent a min of 5 days or until the INH > 2 for 24-48 hours before stopping warfarin

7

What else can you use for Tx of VTE?

DOACs

8

How long do you treat for?

-Treat for 3 months if it was provoked or first episode of unprovoked distal DVT
-First unprovoked event = min of 3 months but can be longer
-Extended treatment if it's related to cancer or 2nd episode of unprovoked VTE

9

The dose of UH is adjusted to prolong the aPTT to a time that corresponds to a heparin anti-Xa level of _____

0.3-0.7

10

When using warfarin, target what INR?

2-3

11

Do ASA and NSAIDs affect INR?

no but they do increase bleed risk

12

list some herbal products that interact with warfarin?

ginkgo, ginseng, st. johns wort

13

Are thrombolytics approved for tx of VTE?

no, but can use alteplase for PE

In patients with hypotension who do not have a high risk of bleeding, thrombolytic therapy is suggested

14

Prophylaxis of VTE is generally how long

10-14 days

15

Non-pharms for prophylaxis of VTE

graduated compression stockings and pneumatic compression devices decrease risk of VTE

16

T or F: LMWH are approved for both treatment and prevention of VTE

true

17

list some LMWH

-dalteparin
-enoxaparin
-nadroparin
-tinzaparin

18

UH is approved for prevention of VTE in which patients?

only for patients undergoing procedures with moderate risk

19

Who is fondaparinux approved for the prevention of VTE in?

approved for prevention of VTE in high-risk orthopedic patients

20

When can DOACs be used for prevention of VTE?

following elective total hip or knee replacement surgery

21

Can also use _____ for prevention of VTE

warfarin (vitamin K antagonist)

22

What is the Virchow triad?

-venous stasis
-damage/injury
-hypercoagulability

23

What is DOC in pregnancy?

LMWH (it induces less bone loss)
*UH used if LMWH not available
*can use fondaparinux if other agents can't be used


*do not use DOACs or warfarin

24

Does LMWH or UH cross placenta?

neither of them cross placental barrier

25

How long do you treat in pregnancy?

min 3 months

26

What are we monitoring in pregnancy?

monitor anti-Xa levels to achieve a target of 0.5-1.0 U/mL 3-6 hours post dose

27

Why do we avoid warfarin in pregnancy?

teratogenic effects.

28

What can be used while breastfeeding?

warfarin, UH, LMWH may be used for 6 weeks after delivery for secondary prevention

29

What 2 drugs are approved for treatment of HIT (heparin-induced thrombocytopenia)

-argatroban
-danaparoid

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