Propylaxis/Treatmetn of Thromboembolic Disease

Question 1

Define anticoagulants

Answer 1

Prevent clot formation and extension

Question 2

Anticoagulant Examples

Answer 2

Warfarin, LMWH, fondaparinux

Question 3

Antiplatelet drugs examples

Answer 3

Aspirin

Clopidogrel

Question 4

Thrombolytic Agents

Answer 4

Alteplase
Reteplase
Tenecteplase

Question 5

When do you give prophylaxis?

Answer 5

Medical/Surgical
Stroke
Valve replacement

Question 6

When do you treat?

Answer 6

Acute VTE

Prevent recurrent VTE

Question 7

Patient RF for prophylaxis treatment

Answer 7

CHF, COPD, stroke, sepsis, previous VTE, ICU, thrombophillia

Question 8

Medical pts who need prophylaxis treatment

Answer 8

> 40
Limited mobility >3d
1 RF
ICU with no mobility

Question 9

SCORE IT

Answer 9

Surgery
Cancer/CV
Obesity
Respiratory Failure
Elderly

Infxn/Inflammatory/Immobile/ICU
Trauma/thromboembolism

Each = 1 point

Question 10

Low Risk

Answer 10

</=1 OR

Minor surgery

Question 11

Moderate Risk

Answer 11

Score of 2
OR Major surgery
AND >40 yo

Question 12

High Risk

Answer 12

Score of 3/4 OR
Over 40
AND major surgery or heart infection and additional RF

Question 13

Very High Risk

Answer 13

Score >/= 5 OR

Major surgery + >40 + history of TE, hip fracture or joint procedure, stroke, malignancy, or additional RF

Question 14

Low Risk Treatment

Answer 14

Early and aggressive ambulation

Question 15

Moderate Risk Treatment

Answer 15

Low dose UFH or LMWK or Fondaparinux OR Mechanical thromboprophylaxis

Question 16

High Risk Treatment

Answer 16

Low dose UFH or LMWK or Fondaparinux OR warfarin or rivaroxaben or Mechanical thromboprophylaxis

Question 17

Mechanical prophylaxis

Answer 17

Intermittent pneumatic compression
Graduated compression stockings
Venous foot pump

Question 18

Low dose UFH dose

Answer 18

5000u SQ Q8H

Question 19

LMWH Enoxaparin Dose

Answer 19

40 mg SQ daily
30 mg if knee or CrCl <30
Increase dose by 30% if over BMI 40

Question 20

Dalteparin Dose

Answer 20

5000uor 2500u SQ QD

Question 21

Fondaparinux Dose

Answer 21

2.5 mg SQ QD unless under 50kg

Question 22

Rivaroxaban dose

Answer 22

10 mg PO QD hip or knee

Watch CrCl <30

Question 23

Apixaban dose

Answer 23

2.5 mg BID beginning 12-24 post-op for 35 days

Watch CrCl <30

Question 24

Moderate risk Duration

Answer 24

Until ambulatory

Question 25

High risk duration

Answer 25

10-35 days for orthopedic surgery OR until ambulatory

Question 26

Safety Monitoring

Answer 26

Platelets S/Sx of bleeding INR for warfarin Anti-Xa for LMWH

Question 27

Therapeutic Dosing When?

Answer 27

When a thrombus is present DVT, PE, atrial fibrillation, heart valve Stroke (CHADS2 score) Heart valve patients

Question 28

Stroke CHADS2 Score

Answer 28

``` CHF HTN Age>75 DM Stroke TIA Score of 1-2 or greater = full dose ```

Question 29

Pt Assessment Treatment Consideration

Answer 29

``` Renal or hepatic disease Alcoholism Obesity or underweight Bleeding or fall risk Ability to self-inject Ability to follow up for lab monitoring $$$$ ```