DVT/PE and Drugs

Question 1

What is Virchow’s Triad?

Answer 1

hypercoagulability
- congenital (thrombophilia) or acquired (infection)

alteration in blood flowing vessel
- immobility, venous stasis

vessel wall injury/endothelial damage
- vascular damage

Question 2

What are the symptoms of pulmonary embolism?

Answer 2

sudden, sharp chest pain
haemoptysis (blood in sputum)
coughing
pleuritic pain (pain upon inspiration)

nausea, vomiting, sweating
dizziness
palpitations
dyspnoea
leg pain or swelling

Question 3

What are the symptoms of pericarditis?

Answer 3

sudden, sharp left sided pain
- over the heart
- does not radiate
- pleuritic pain (pain upon inspiration)
- relieved by leaning forward

fever
dyspnoea
nausea
dizziness

Question 4

How should pulmonary embolism be treated?

Answer 4

direct oral anticoagulants
- apixaban, edoxaban

vitamin k antagonists
- warfarin

tissue plasminogen activator
- alteplase, reteplase

Question 5

What are anti-coagulants? What are the different types?

Answer 5

drugs that prevent the build up of blood clots by reducing fibrin formation

vitamin K antagonists
- warfarin

direct oral anti coagulants
- direct FXa inhibitor = apixaban, edoxaban
- direct FIIa inhibitor = dabigatran, bivalirudin

low molecular weight heparin
- dalteparin, enoxaparin

Question 6

What are anti-platelets? What are the different types?

Answer 6

drugs that prevent platelets from clumping and prevent thrombus formation

aspirin - binds to COX-1 to block TXA2 formation and subsequent GP IIb/IIa complex activation
clopidogrel/prasugrel - binds to P2Y12 to block ADP mediated GP IIb/IIa complex activation
abciximab - blocks binding of fibrinogen to GP IIb/IIa receptor

Question 7

What are thrombolytics? What are the different types?

Answer 7

drugs that breakdown clots

alteplase, reteplase, streptokinase
- converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin as well as fibrinogen

Question 8

Which anticoagulant should be used in AF stroke prevention, PE/DVT and mechanical heart valves

Answer 8

AF stroke prevention
- DOAC (rivaroxaban), warfarin

PE/DVT
- DOAC (dabigatran, apixaban), warfarin

mechanical heart valves
- warfarin

Question 9

What are symptoms of bleeding caused by anticoagulants in the gastrointestinal tract and brain?

Answer 9

GI tract bleeding
- dark or bright red blood mixed with stool or black stools
- dizziness
- dyspnoea

brain
- sudden onset severe headache
- loss of vision
- slurring of speech
- dysphagia
- loss of balance
- sudden weakness of face, arm or leg, possibly on one side

brusing and nose bleeds are most common

Question 10

What is heparin induced thrombocytopenia (HIT)? What is it caused by? How can it be treated?

Answer 10

the development of thrombocytopenia (low platelet count) due to the administration of heparin
- caused by the formation of abnormal antibodies that activate platelets

treated using argatroban
- factor IIa (thrombin) inhibitor