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Anticoagulation Disorders Flashcards

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1
Q

What are the risk factors for VTE?

A
  1. Age > 50
  2. Family hx
  3. Venous stasis
  4. Vascular injury
  5. Hypercoagulable disorders
  6. Drugs
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2
Q

What are the 3 components of Virchow’s Triad?

A
  1. Venous stasis
  2. Vascular injury
  3. Hypercoagulability
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3
Q

What falls under venous stasis in Virchow’s Triad?

A
  1. immobility
  2. paralysis
  3. atrial fibrillation
  4. LV dysfunction
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4
Q

What falls under vascular injury in Virchow’s Triad?

A
  1. indwelling catheter
  2. trauma
  3. surgery
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5
Q

What falls under hypercoagulability in Virchow’s Triad?

A
  1. protein C & S deficiencies
  2. antithrombin deficiency
  3. malignancy
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6
Q

What are the hereditary hypercoagulable disorders?

A
  1. Activated Protein C resistance/Factor V leiden mutation
  2. Prothrombin gene mutation
  3. Protein C deficiency
  4. Protein S deficiency
  5. Antithrombin deficiency
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7
Q

What are the acquired hypercoagulable disorders?

A
  1. pregnancy
  2. antiphospholipid antibodies
  3. drug therapy
  4. malignancy
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8
Q

What are the implications of cancer-associated VTE?

A
  1. increased mortality
  2. increased risk of fatal PE
  3. increased risk of recurrent VTE
  4. increased risk of bleeding
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9
Q

What are the four categories of risk factors for cancer-associated VTE?

A
  1. cancer related
  2. treatment related
  3. patient related
  4. biomarkers
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10
Q

What are the cancer related risk factors?

A
  1. primary site
  2. cancer histology
  3. time after diagnosis
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11
Q

What are the treatment related risk factors?

A
  1. chemotherapy
  2. antiangiogenic agents
  3. hormonal therapy
  4. erythropoiesis agents
  5. transfusions
  6. indwelling ports
  7. radiation
  8. surgery > 60 min
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12
Q

What are the patient related risk factors?

A
  1. older age
  2. race
  3. medical comorbidities
  4. obesity
  5. Hx of VTE
  6. low performance status
  7. inherited mutations
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13
Q

What are the biomarker risk factors?

A
  1. platelet count ≥ 350,000
  2. WBC count > 11,000
  3. hemoglobin < 10
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14
Q

Which cancers have a high risk for VTE?

A

pancreas, liver, stomach, esophagus, brain, leukemia, and lymphoma

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15
Q

Which cancers have an intermediate risk for VTE?

A

multiple myeloma, myeloproliferative neoplasm, lung, kidney, bladder, and prostate

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16
Q

Which cancers have a low risk for VTE?

A

ovary, breast, myelodysplastic syndrome, colon, and rectal

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17
Q

What are the S/Sx of DVT?

A
  1. unilateral calf pain or thigh swelling
  2. leg pain/calf tenderness
  3. increased leg warmth
  4. edema
  5. erythema
  6. palpable thrombosed veins
  7. homans sign
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18
Q

What are the S/Sx of PE?

A
  1. dyspnea
  2. tachypnea
  3. tachycardia
  4. hemoptysis
  5. chest pain and/or tightness
  6. cough
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19
Q

What is d-dimer?

Study These Flashcards
A

a by-product of thrombin

20
Q

What is the normal range of d-dimer?

21
Q

What is the non-invasive test for DVT?

Study These Flashcards
A

duplex ultrasonography

22
Q

What is the downside to duplex ultrasonography?

Study These Flashcards
A

It can’t reliably detect small blood clots in distal veins

23
Q

What is the invasive test for DVT?

Study These Flashcards
A

contrast venography

24
Q

What are the downsides to contrast venography?

Study These Flashcards
A

placement of catheter, iodinated contrast, and radiation exposure

25
What are the contraindications for contrast venography?
renal dysfunction and dye allergy
26
What are the non-invasive tests for PE?
Ventilation-perfusion scanning and contrast-enhanced spiral chest CT
27
When is V/Q scanning preferred?
In patients with kidney disease or with allergies to contrast dye
28
What is the invasive test for PE?
pulmonary angiography
29
What are the contraindications for pulmonary angiography?
renal dysfunction and dye allergy
30
What is the dosing for treatment of VTE with UFH?
80 U/Kg IV bolus + 18 U/kg/hr IV
31
What is the goal of UFH?
aPTT 0.3-0.7 IU/mL
32
What is the outpatient treatment regimen with enoxaparin?
1 mg/kg SC q12h
33
What is the inpatient treatment regimen with enoxaparin?
1 mg/kg SC q12h or 1.5 mg/kg qd
34
What is the dose adjustment of enoxaparin if CrCl < 30?
1 mg/kg SC q24h
35
What is the treatment regimen with dalteparin?
200 IU/kg SC once daily for 1 month, then 150 IU/kg SC once daily for 5 months
36
What is the target anti Xa level in patients with CrCl < 30?
0.5-1.5 IU/mL
37
What is the treatment regimen with tinzaparin?
175 IU/kg SC once daily
38
What is the treatment regimen for fondaparinux for weight < 50 kg?
5 mg SC daily
39
What is the treatment regimen for fondaparinux for weight 50-100 kg?
7.5 mg SC daily
40
What is the treatment regimen for fondaparinux for weight > 100 kg?
10 mg SC daily
41
Which drug is contraindicated in CrCl < 30?
fondaparinux
42
What is the goal range of anti-Xa for enoxaparin, dalteparin, and tinzaparin?
0.5-1.0 IU/mL
43
What is the preferred agent for long-term anticoagulation therapy?
LMWH given for at least 6 months
44
What are the disadvantages of warfarin in cancer?
1. narrow therapeutic window 2. frequent monitoring 3. drug and food interactions 4. interruptions due to procedures 5. resistance
45
What are the advantages of LMWH in cancer?
1. body weight adjusted dose 2. no labs 3. predictable response 4. rapid onset 5. Less recurrence and bleeding (dalteparin)
46
What is the only acceptable alternative for VTE management if a patient denies LMWH?
apixaban

Hem/Onc (4 decks)

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