Chapter 2 - Blood Clots Flashcards Preview

Pharmacy Pre-Reg 2020/2021 > Chapter 2 - Blood Clots > Flashcards

Flashcards in Chapter 2 - Blood Clots Deck (146)
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1

What drugs are used for treating blocked catheters and lines?

Unfractionated heparin
Urokinase
Epoprostenol

2

What is a VTE, and what are the two main examples of a VTE?

A VTE is a blood clot in a vein that completely obstructs the flow of blood?

DVT - the blood clot occurs in the deep veins of the legs or pelvis

PE - the blood clot obstructs the flow of blood to the lungs

3

What is hospital acquired VTE?

A VTE occurring within 90 days of hospital admission?

4

What are the symptoms of VTE?

Throbbing and/or swelling in one leg

Warm skin around the painful area

Red or darkened skin around the painful area

Swollen veins that are hard or sore when touched

5

What are the symptoms of PE?

Coughing up blood
SOB/breathlessness
Chest pain/upper back pain

6

What are the risk factors for VTE?

Surgery
Trauma
Significant immobility
Malignancy
Obesity
Hypercoagulable states
Pregnancy and the postpartum period
Hormonal therapy (combined oral contraception, HRT)

7

What are the two methods of VTE thromboprophylaxis?

Mechanical
Anti-embolism stockings
Intermittent pneumatic compression

Pharmacological
LMWH
UH
Fondaparinux sodium

8

What calf pressure are we aiming for when using mechanical VTE prophylaxis?

14-15 mmHg

9

How long is mechanical VTE prophylaxis used for?

Wear day and night for 30 days or until the patient is sufficiently mobile

10

When should pharmacological VTE prophylaxis be started?

ASAP or within 14 hours of admission

11

How long is pharmacological VTE prophylaxis used for?

7 days or for the duration of hospital stay, whichever is longer

28 days after major cancer surgery in the abdomen
30 days after spinal injury

12

What needs to be assessed daily whist a patient is on VTE prophylaxis in hospital?

Bleeding risk (HAS-BLED)

13

What type of anaesthesia needs to be used for surgical patients requiring VTE prophylaxis?

Regional (not general) if possible

14

Do surgery patients require VTE prophylaxis?

Patient schedules for surgery are given anti embolism stockings on admission, and are worn until the patient is sufficiently mobile.

If the risk of VTE is high (and higher than the risk of bleeding), pharmacological prophylaxis is also used and continued for 7 days
(28 days abdominal cancer surgery, 30 days spinal injury).

Pharmacological VTE prophylaxis is usually LMWH, but can be UFH or fondaparinux.

15

What VTE prophylaxis is given in hip replacement?

Usually a LMWH for 10 days then low-dose aspirin for 28 days

16

What VTE prophylaxis is given in knee replacement?

14 days low-dose aspirin

17

What should be given to pregnant women or women who have given birth , had a miscarriage or terminated a pregnancy in the last 6 weeks, who’s VTE risk is higher than their bleeding risk?

LMWH e.g. dalterparin

If there is likely to be sufficient immobility, also consider mechanical VTE prophylaxis
First line is intermittent pneumatic compression

18

What is given for confirmed VTE?

Apixaban or rivaroxaban

For at least 3 months

19

What is the preferred treatment for VTE in pregnancy and why?

Heparins, LMWH is preferred, because:

It doesn’t cross the placenta

It has a lower risk of osteoporosis

It has a lower risk of heparin-induced thrombocytopenia

LMWH are excreted more rapidly in pregnancy (the dose may need to be altered)
Stop treatment at the end of labour

20

What do you do in the event of haemorrhage during VTE treatment?

Withdraw the heparin

If necessary, administer protamine (but this only partially reverses the effect of LMWH)

21

What are the three main types of stroke?

Ischaemic stroke- a blockage cutting off blood supply to the Brian

TIA - same as above, it is temporary and the blood flow returns on its own

Haemorrhagic stroke - bleeding in or around the brain

22

How is a TIA treated

Patients should immediately receive 300mg aspirin, and should receive secondary prevention

23

How is an ischaemic stroke managed? Both short and long term

Initial management:
Alteplase should be administered within 4.5 hours of symptom onset
Aspirin should be initiated ASAP and continued for 14 days
Some patients may also require a PPI

Long term management:
Clopidogrel (unlicensed in TIA)
Within 48 hours start a high intensity statin (e.g. atorvastatin) regardless of serum cholesterol (aim to reduce non-HDL cholesterol by more than 40%)

Also monitor BP, and advise lifestyle modifications

24

What assessment tool is used to assess the likelihood of a VTE?

Two-level Wells Score


Also use the HAS-BLED score to assess the risk of bleeding

25

In an ischaemic stroke, what is the target BP?

<130/80 mmHg

Don’t use beta-blockers alone

26

How is a haemorrhagic stroke managed?

Surgery

Aspirin long-term if the patient is at risk of another cardiac event

27

What is the lifestyle advice to prevent a VTE?

Stay active
Lose weight if overweight
Quit smoking if applicable
Lower BP avoid sitting for long periods of time
Drink plenty of fluids - DVT is more likely when dehydrated

28

What type of mechanical prophylaxis is used to prevent VTE in patients with
a) an acute stroke?
b) pregnancy?

Both: intermittent pneumatic compression

29

Do anticoagulants destroy an arterial thrombus?

No, for 2 reasons:

They PREVENT thrombus formation in the VEINS

30

What is the main adverse event with anticoagulants?

Haemorrhage