PAD and VTE Flashcards
(22 cards)
2 Differences in symptom management for ASX vs SX PAD
- SAPT for ASX treatment, DAPT is absolutely needed for Sx PAD
- Cilostazol for claudication sx of PAD
Antiplatelet Tx for PAD
ASX: Consider SAPT with ASA or Clopidogrel
SX:
- ASA and Xorelto (rivaroxaban)
- ASA and Clopidogrel (Plavix)
Cholestorol goal for someone with PAD
<70 LDL is goal (Use ezetimibe or PCSK9 if needed) to prevent MACE
Cilostazol indication
- Antiplatlet and vasodilator, use in combo with asprin or clopidogrel
- Improves claudication sx, but doesn’t prevent MACE.
SEs: headache, diarrhea, dizziness, palpitations
Vaccines recommended for all PAD pts
Flu and COVID
CIs of starting a patient on an ARB
1) Bilateral renal stenosis
2) Hyperkalemia
3) Acute renal failure (Ok to give if they have it chronically)
- Be careful if hx of angioedema, hyponatremia, gout, or cough from ACEs
Tx for critical limb ischemia
IV Anticoagulation (heparin drip) immediately
Embolectomy or thrombolysis with alteplase depending on severity
Tx for raynaud’s disease
- DHP CCBs (nifedipine, amlodipine)
- A1 antagonists (Prazosin)
- PDE-5 inhibitors (sildenafil)
Major risk factor for VTE
- C section
- Surgery >30 minutes
- Hospitalized for >3 days
What does the Wells pretest probability test
Tests if you should order a D-dimer or diagnostics to rule out a PE or DVT
What does the PESI or NEWs test
Tests if you should admit or discharge a PE patient
-Increased if Male, Hx of cancer/HF/Lung disease, Tachycardic, Low BP, High RR, AMS, O2 sat less tahn 90%
Anticoagulation for VTE treatment preference
DOAC>warfarin
For cancer pts: Anti Xa>LMWH
If your patient has cancer, which Anticoagulant is preferred if they get a VTE
6x greater risk of VTE if you have cancer
Give Anti Xa (Rivoroxaban, apixiban) if they need tx.
If your patient has APS, what is the preferred anticoagulant for DVT
Warfarin>DOACs
Tx for acute isolated DVT of distal leg
Serial imaging over 2 weeks > anticoagulation if no RF
If RF, Anticoagulatioin>serial imaging
Acute Proximal DVT Tx
Anticoagulation alone>interventional therapy
How long do you anticoagulate for if someone has a DVT
at least 3 months, longer if persistent RF, lifelong if recurrent VTE.
- Doacs preferred for most
- Anti Xa for cancer
- Warfarin preferred for APS
- LMWH preferred if pregnant
How do you treat an incidental finding of a PE that is asx
Treat like sx
Subsegmental PE with no proximal DVT of the legs treatment
Low Risk for recurrent, surveillance> anticoagulation
High risk of refurrent, Anticoagulation>survillance
When to choose LMWH or UFH over oral agents in VTE
- Pregnancy
- Unable to take orals
- Severe Sx, PE that is hemodynamically unstable
- Impending Sx intervention (Half life of injectibles is much shorter than orals)
VTE occurs in which hospital patients most commonly
Post-total hip or knee replacements
- Up to 70% of these VTEs are preventable
Get SICs on people who can’t recieve anticoagulation
Pharmacologic VTE prophylaxis is required for which patients
1) All hospitalized medical patients (low dose LMWH, Heparin, rivaroxaban). Up to a month after hospital discharge in high risk pts (COVID)
2) After Hip/knee arthroplasty ( rivaroxaban, LMWH) 2-4 week Tx
