Day 5 Cardiology Flashcards
(10 cards)
What are the 3 components of Virchow’s triad?
risk factors for VTE?
What labt test is used to test for both VTE and PE?
Hypercoaguble state(malignancy, gene mutations(factor V leidin), hereditary dysfunction(Protein C&S), Pregnancy), Vascular injury(major orthopedic surgery, trauma, fracture, indwelling venous catheters), Venous stasis(illness, HF, paralysis, surgery, polycythemia vera, obesity, varicose veins)
Age>40, obesity, History of VTE(strongest risk factor), Cancer, Bed rest>5 days, major surgery, HF, Varicose veins, stroke, fracture, estrogen treatment, multiple trauma, childbirth, MI.
D-dimer test.
What is the gold standard for DVT? PE? Are they generally done?
Non pharmacologic VTE prevention?
Heparin dose for VTE prevention?
Venography, Pulmonary Angiography. No, highly invasive and expensive.
Ambulation, GCS(compression stockings),IPC Devices,IVC filters(prevents embolizim, do not prevent formation of a thrombus).
5000 units SubQ every 8 or 12 hours. No monitoring of aPTT needed for prophylaxis.
Enoxaparin dose for VTE prevention?
Fondaparinux dose for VTE prevention?
DOAC things to know about VTE prevention?
30 mg SubQ every 12 hours(high risk) or 40 mg SubQ daily, CrCl<30mL/min; Adjust dose to 30 mg daily.
2.5 mg SubQ daily,CrCl <30mL/min CI’d.
CrCl<30 for dabigatran don’t use, for Rivaroxaban avoid use and avoid in hepatic impairment, Don’t use Apixaban if lower than <30.
If low risk surgery for non ortho what do you recommend?
Moderate?
High?
Early ambulation
LMWH or low dose UFH, IPC.
LMWH or low dose UFH plus IPC.
Orthopedic surgery recommendations for VTE?
Medically ill patients?
Trauma?
Minimum 10-14 days therapy(up to 35 days), Medicaly therapy plus IPC’s, LMWH preferred.
LMWH, low dose UFH, or Fondaparinux, Duration of therapy is only for period of immobilization or duration of hospital stay.
LMWH preferred(high dose) +/- mechanical prophylaxis, mechanical can be used alone if antithrombotics are CI, duration of therapy until discharged.
Acute treatment?
UFH treatment for acute treatment?
Enoxaparin dosing for acute treatment?
SC LMWH or Fondaparinux, IV or SC UFH, oral Xa inhibitors
IV: 80 units/kg bolus followed by 18 units/kg/hr drip. Monitor every 6 hours and adjust drip rate or subq dose based on lab value. Aim for aPTT 60-100 seconds.
1 mg/kg SubQ BID or 1.5 mg/kg SubQ once daily. 1 mg/kg subQ once daily if CrCl<30.
Fondaparinux dosing?
Fibrinolytics for acute treatment?
What DOAC’s can you not use with <30CrCl? Edoxaban dosing?
Cut the 0’s off.
Alteplase, still anticoagulate with UHF, CDT recommended over systemic administration for DVT, PE it’s recommended for systemic administration.
Rivaroxaban,CrCl 10-15 30mg PO qday, requires 5 day bridge.
How to monitor warfarin?
Counseling points for warfarin?
Drug of choice for long term treatment for cancer and pregnant patients?
Daily INR’s for at least 5 days. Once INR is therapeutic for 2-3 doses then weekly. Once INR is stable it’s every 12 weeks.
Explain high and low INR, compliance, drug interactions, dietary interaction, alcohol, sign/symptoms of clotting, sign/symptoms of bleeding.
LMWH
When to use DOAC’s?
Difference between unprovoked and provoked DVT?
DVT/PE provoked by surgery treatment duration?
DVT of leg or PE, and no cancer.
Provoked- secondary, Unprovoked- no identifiable cause
3 months
Unprovoked(1st or 2nd) DVT or PE?
How to treat pregnancy DVT?
Enoxaparin obese patient recommendation?
3 months of treatment then evaluate bleeding risk(low-moderate run therapy longer, high risk- stop anticoagulation and recommend aspirin).
LMWH, discontinue 24 hours before delivery, continue 6 weeks after delivery and at least 3 months of therapy, anti-xa are encouraged
Prophylaxis- 0.5mg/kg or 60 mg once daily, 1mg/kg BID dosing.
