Thromboembolism

Question 1

Tx for confirmed proximal DVT or PE

Answer 1

1st = apixaban or rivaroxaban

2nd = LMWH for 5 days followed by dabigatran or edoxaban or LMWH + warfarin for 5 days or until INR is 2 for 2 consecutive readings, then warfarin alone

Question 2

Duration of VTE treatment
- 4 types

Answer 2

provoked DVT = 3 months
unprovoked DVT = >3 months
Active cancer = 3-6 months
Recurrent = long term

Question 3

What is mechanical thromboprophylaxis

Answer 3

Graduated compression stockings to be worn day and night until fully mobilised

Question 4

What is pharmacological thromboprophylaxis

Answer 4

• Start anticoagulants within 14 hours of admission
• Patients with risk factors should receive pharmacological prophylaxis when risk of VTE outweighs their risk of bleeding

Question 5

Pharmacological VTE prophylaxis before surgery
How long is it continued in
- general
- major cancer surgery
- spinal surgery

Answer 5

• LMWH or fondaparinux
• continue for at least 7 days post-op or until sufficiently mobile
• 28 days after major cancer surgery in the abdomen
• 30 days in spinal surgery

Question 6

Elective hip replacement VTE prophylaxis

Answer 6

• LMWH for 10 days and then 75mg aspirin for 28 days
• LMWH for 28 days + stockings until discharge
• rivaroxaban/apixaban/dabigatran

Question 7

Elective knee replacement VTE prophylaxis

Answer 7

• 75mg aspirin for 14 days
• LMWH for 14 days + stockings until discharge
• rivaroxaban/apixaban/dabigatran

Question 8

VTE prophylaxis in pregnancy

Answer 8

• If risk of VTE outweighs risk of bleeding: LMWH during admission
• prophylaxis until no risk of VTE or discharge

Question 9

VTE prophylaxis after birth, a miscarriage or termination of pregnancy

Answer 9

LMWH 4-8 hours after event for a minimum of 7 days