DVT/PE

Question 1

A patient in critical care, with cancer, stroke, preg, HF, MI, previous VTE, prolonged immobility, renal failure, or hypercoag state is in what category for a VTE?

Answer 1

High risk

Question 2

How do you prevent a VTE in a low risk patient?

Answer 2

Pharm, early ambulation, and SCD’s

Question 3

How do we prevent VTE in the hospital setting for a high risk patient?

Answer 3

Pharm (LMWH or UFH)

Question 4

Does a patient need to continue LMWH or UFH at home? Nursing facility?

Answer 4

NO need to continue at home

If absolutely necessary, you can continue if they go to SNF

Question 5

When we prescribe heparin, what should we always look out for?

Answer 5

Heparin induced thrombocytopenia

Use the 4 T’s calculator to evaluate risk

(50% reduction in PLT) → stop all heparin!!!

Question 6

If a patient on heparin and their platelets drop by 50%, what should we do?

Answer 6

Stop ALL HEPARIN PRODUCTS!!! Including heparin-locks

Use Arixtra

Question 7

What are some exam findings we would see with a VTE?

Answer 7

Palpable cord, +Homan’s sign, edema, and discoloration

Question 8

If a patient has a low Well’s criteria – what should we do?

Answer 8

Get an ultrasound and a D-Dimer

Question 9

How do we treat a DVT in the hospital (classically)?

Answer 9

Admit → confirm with US → anticoag (Heparin + warfarin on day one!!!!) → have a case manager to help with home SQ injections

Question 10

How long do we continue the heparin or lovenox?

Answer 10

MINIMUM 5 DAYS

Question 11

What are some of the new changes to DVT treatment?

Answer 11

Direct oral agents (Rivaroxaban and Apixaban ONLY)
*No HEPARIN OVERLAP

Must be taken several times a day (can’t skip doses!) no eGFR less than 30

Question 12

If a patient presents with dyspnea, pleuritic chest pain, cough, orthopnea, wheezing, and hemoptysis – what type of PE is this?

Answer 12

Submassive