STEP2: THROMBOEMBOLIC Flashcards
(4 cards)
Treatment for hemodynamically stable patients with acute mesenteric ischemia who do not present with signs or symptoms of advanced intestinal ischemia (e.g., peritonitis, sepsis).
Endovascular revascularization
Initial treatment [17][23][24]
Initiate supportive measures.
Administer supplemental oxygen.
Begin IV fluid resuscitation.
Insert a nasogastric tube and keep the patient NPO.
Start broad-spectrum IV antibiotics: See “Empiric antibiotic therapy for intraabdominal infections.”
Begin parenteral anticoagulation with unfractionated heparin.
Definitive treatment [15]
Surgical
Bowel resection (of necrotic segments)
Revascularization: open embolectomy and/or mesenteric bypass surgery
Damage control surgery (with or without temporary abdominal closure): for critically ill patients
Endovascular revascularization
Mechanical removal of the emboli or thrombus
Angioplasty with or without stenting of the mesenteric artery
Catheter-directed intraarterial infusion of thrombolytics or vasodilators (e.g., papaverine)
What is our approach to treating TIA?
Generally, patients with TIA should receive immediate antiplatelet therapy (e.g., aspirin) unless they have a clear indication for anticoagulation at initial presentation (e.g., Afib). If this is the case, antiplatelet therapy can be replaced with anticoagulation to prevent thromboembolism. A patient with TIA and concomitant Afib on initial presentation should undergo evaluation for anticoagulation to prevent future complications of Afib (e.g., systemic embolization with TIA).
A patient is due to undergo major pelvic surgery. Her age, BMI, and history of endometrial cancer put her at increased risk of developing deep venous thrombosis (DVT) after surgery. What prophylaxis will you consider?
Enoxaparin is a low molecular weight heparin (LMWH) commonly used for DVT prophylaxis in individuals at increased risk of thrombotic complications.
Fractionated heparin
Low molecular weight heparin
Complication of umbilical catheterization
Renal artery thrombosis leading to increased BP from elevated renin production
