Thromboembolism Flashcards
(33 cards)
When would a VTE be considered hospital-acquired?
If it occurs within 90 days of hospital admission
Risk factors for VTE
Surgery
Trauma
Significant immobility e.g., hospitalisation or long haul flight
Malignancy
Obesity
Pregnancy and postpartum period
Hormonal therapy (COC or HRT)
Symptoms of DVT
Swelling
Hot to touch
Painful
One leg
Unilateral localised pain
If DVT dislodged can lead to PE
Symptoms of PE
SOB
Coughing
Chest pain
Diagnostic test for VTE
D-dimer
VTE prophylaxis
Mechanical - compression stockings
Pharmacological
Within how many hours of admission should pharmacological VTE prophylaxis be started?
14 hours
What VTE prophylaxis is used in a general / orthopaedic surgical patient?
Mechanical
Pharmacological with LMWH
Which pharmacological VTE prophylaxis is preferred in patients with renal impairment?
Unfractionated heparin
Which pharmacological VTE prophylaxis is preferred in patients at high risk of bleeding and why?
Unfractionated heparin
Shorter half-life
Which pharmacological VTE prophylaxis is preferred in patients with lower limb immobilisation (knee replacement) or pelvis fragility fractures, or cardiac / bariatric surgery?
Fondaparinux sodium
For how long after surgery is pharmacological therapy generally continued?
At least 7 days or until sufficient mobility has been reestablished
For how long after cancer surgery in the abdomen should VTE prophylaxis be continued?
28 days
For how long after spinal or cranial surgery should VTE prophylaxis be continued?
30 days
For how long after elective hip replacement surgery should VTE prophylaxis be continued? Which drugs are used?
LMWH for 10 days then low-dose aspirin for 28 days
LMWH for 28 days in combination with stockings until discharge
Rivaroxaban
For how long after elective knee replacement surgery should VTE prophylaxis be continued? Which drugs are used?
75mg aspirin for 14 days
LMWH for 14 days in + stockings until discharge
Rivaroxaban
Apixaban or Dabigatran can be considered as alternatives
VTE prophylaxis for general medical patients
LMWH min 7 days
Fondaparinux min 7 days
Renal impairment = unfractionated heparin
VTE prophylaxis in acute stroke patients
Mechanical stockings - started within 3 days and continued for 30 days post stroke or until sufficiently mobile
VTE prophylaxis in pregnancy (duration and risk factors)
Women who have given birth, had a miscarriage or termination of pregnancy during the past 6 weeks - start LMWH within 4-8 hours and continued for a min of 7 days
Continued until there is no longer VTE risk or until discharge
Additional mechanical prophylaxis if immobilised until sufficiently mobile or discharged from hospital
Baseline blood tests when starting anticoagulation treatment
FBC
Renal function
Hepatic function
Coagulation screening - Prothrombin time
Treatment of confirmed proximal DVT or PE
1st: Apixaban or Rivaroxaban
2nd: LMWH for at least 5 days followed by Dabigatran or Edoxaban
3rd: LMWH and warfarin for at least 5 days or until INR is 2.0 for 2 consecutive readings then warfarin by itself
Treatment of confirmed proximal DVT or PE with renal impairment (CrCl 15-50ml/min)
1st: Apixaban or Rivaroxaban
2nd: LMWH for at least 5 days followed by Dabigatran (if CrCl >30ml/min) or Edoxaban
3rd: LMWH or unfractionated heparin and warfarin for at least 5 days or until INR is 2.0 for 2 consecutive readings then warfarin by itself
Duration of confirmed proximal DVT or PE treatment
Min. 3 months
Duration of confirmed provoked DVT or PE treatment
Consider stopping at 3 months if the provoking factor is no longer present
