DVT

Question 1

Where do arterial thrombi typically occur and initiated

Answer 1

In areas of rapid blood flow, often initiated by spontaneous or mechanical rupture of atherosclerotic plaques.

Question 2

What are the main components of venous thrombi?

Answer 2

Fibrin and erythrocytes (red blood cells).

Question 3

Where are venous thrombi most commonly found and what ‘re provocations for VTE

Answer 3

found primarily in the venous circulation
provoked by: Prolonged immobility and vascular injury.

Question 4

In what type of patients is VTE most frequently seen?

Answer 4

Patients hospitalized for serious illness, trauma, or major surgery.

Question 5

What are the possible outcomes of a formed venous thrombus?

Answer 5

• Remain asymptomatic (cause no symptoms)
• Spontaneously lyse (dissolve)
• Obstruct the venous circulation
• Circulate to other veins and embolize (break off and travel)
• Slowly incorporate into the vessel wall

Question 6

VTE Impact & avoiding treatment

Answer 6

VTE can be debilitating or fatal, avoid treatment if diagnosis is not confirmed because treatment may cause major bleeding which might be equally harmful

Question 7

DVT Presentation

Answer 7

Unilateral leg swelling (often starting after sleep), warmth, local tenderness/pain, and skin cyanosis.

Question 8

What percentage of DVT patients are asymptomatic?

Answer 8

Over 50%.

Question 9

What are the common symptoms of PE?

Answer 9

Nonspecific symptoms like dyspnea, pleuritic chest pain, anxiety, cough, and sometimes hemoptysis.
DVT precede PE inc80% or more of cases.

Question 10

Clinical probability of PE:
low
moderate
high

Answer 10

low: 0-1
moderate: 2-6
high: 7 or more thn 7

Question 11

D-dimer Test in DVT Diagnosis

Answer 11

• Used to rule out DVT in low clinical probability cases
• Quantitative measure of fibrin breakdown in serum
• Indicates acute thrombotic activity
• Sensitive but not specific for VTE

Question 12

Contrast Venography in DVT Diagnosis

Answer 12

If the D-dimer test is positive , Contrast venography allows visualization of the entire venous system in the lower extremities.
* Venography is the most accurate and reliable method for diagnosis of DVT
* Venography is an expensive, invasive procedure that is technically difficult to perform and evaluate.
* Severely ill patients may be unable to tolerate the venography, and many develop hypotension and cardiac arrhythmias
* The contrast media used is irritating to vessel walls and toxic to the kidneys

Question 13

What’s the preferred non-invasive DVT diagnosis method?

Answer 13

Duplex ultrasonography.

Question 14

What imaging methods are used for PE diagnosis?

Answer 14

CT, MRI, and Ventilation/Perfusion scans

Question 15

VTE risk factors according to Virchow triad

Answer 15

• Stasis in blood flow (circulatory stasis)
• Vascular endothelial injury
• Inherited or acquired changes in blood constituents causing hypercoagulation states(hypercoagulability)

Question 16

Other risk factors for vte

Answer 16

Age: Risk doubles with each decade after age 50
History of VTE: Strongest known risk factor for DVT & PE
Drug therapy
* Estrogen-containing oral contraceptive pills
* HRT / ERT
* Chemotherapy

Question 17

Fatality in VTE

Answer 17

DVT: Rarely fatal
PE: Death can occur within minutes of symptom onset

Question 18

Complications of VTE?

Answer 18

• Post-thrombotic syndrome (PTS)
• Chronic thromboembolic pulmonary hypertension (CTPH)

PTS: a problem that can develop in nearly half of all patients after DVT.
PTS symptoms include chronic leg pain, swelling, redness, and ulcers

Question 19

non pharmacological treatment of dvt

Answer 19

1- abmulation
2- GCS (graduated compression stocking)
3-(IPC) intermittent pneumatic compression
4- inferior vena cava filters
5-thrombectomy

Question 20

abmulation and its adv

Answer 20

it is walking as soon after surgery
to increase the blood blow - decrease the incidence of vte
promote flow of natural thromobolytic factors into lower extremes

Question 21

GCS adv and disadv

Answer 21

gcs is graduated compression stocking is socks that cause pressure help prevent thrombosis.
- in low moderate patients when pharmacological is contraindicated
- addictive effect when combine with pham
- uncomfortable to some patient, sue to leg shape n size, and hot

Question 22

ipc adv and dis

Answer 22

intermittent pnematic compression
increase velocity of blood flow to lower extremes.
its used in surgical patient to prevent vte, it inflate and deflate in 1-2 min cylce
might be hot, uncomfortable, expensive, difficult sleeping

Question 23

Inferior Vena Cava (IVC) filters

Answer 23

Greenfield filters,
short-term protection against PE in high risk patients
long term use cause thrombogenic themselves and increase the long-term risk of recurrent DVT
last choice

Question 24

thromboctomy

Answer 24

surgically or mechanically
be considered in patients with massive iliofemoral DVT when there is a risk of limb gangrene due to venous occlusion.

Question 25

Anticoagulant Drugs for vte

Answer 25

• Unfractionated heparin (UFH)
• Low molecular weight heparins (LMWHs) like dalteparin, enoxaparin
• Fondaparinux
• Warfarin

Question 26

orthopadic surgey drugs

Answer 26

low dose ufh and warfin used in orthopedic surgery patient
fondaparinux is more effective than LMWH in orthopedic patient but has high risk of bleeding
aspririn modest reduction in vte after othopedic

Question 27

thrombolytic uses and only used in?

Answer 27

• restore venous patency more quickly
• • reserved for patients who present with shock, hypotension, or massive DVT with limb gangrene
    FDA-approved thrombolytics for VTE: streptokinase, alteplase & urokinase

UFH should not be used during thrombolytic therapy.

Question 28

UFH use

Answer 28

will not dissolve a formed clot but prevent its propagation and growth

Question 29

UFH monitoring

Answer 29

appt baseline, 6 hour after infusion and 6 hours after each dose change. cuz css
therapeutic appt should be achived in 24 hours after initiating ufh
hb, hematocrit, platelet and bp shuld be monitro
bleeding risk 1-5% should be monitored sign and symptoms

Question 30

bleeding and SE of UFH

Answer 30

if bleeding occur stop ufh, treat source of bleeding and give protamine sulphate
se: thrombocytopenia: top the drug & use another anticoagulant (not LMWH)

Question 31

long term use of ufh and cautions

Answer 31

lonterm use >1mnth cause increased bone loss
pregnancy cat C
safe in breast feeding women
caution in peripartum period due to risk of maternal hemorrhage.

Question 32

LMWH vs. Heparin Differences

Answer 32

• molecular weight, SE, monitoring, pk
• unlike heparin, lmwh have SC bioavailability: predictable dose response and longer pharmacodynamic effect.
• routine monitoring of appt doesnt require
• less side-effect compared to UFH
• bleeding risk less ( less than 3%)
• Heparin-induced thrombocytopenia less than ufh but still platlet monitoring needed 1st days
• do not cross placenta and is safe in preg

Question 33

LMWH Dosage Determination

Answer 33

patient’s weight
(1.5mg/kg) or twice daily (1mg/kg).
bleeding risk high: 1.5mg/kg
bleeding risk low: 1 mg twice

Question 33

Monitoring with LMWH

Answer 33

antifactor Xa activity measurement in specific situations
* Morbidly obese patients (weight greater than 150 kg)
* Patients <50 kg
* Significant renal impairment
* Children and pregnant women