Thromboembolism- VTE&Stroke&Intracerebral haemorrhage

Question 1

What is venous thromboembolism (VTE)?

Answer 1

VTE includes deep-vein thrombosis (DVT) and pulmonary embolism (PE), referring to a blood clot that forms in a vein, obstructing blood flow.

Question 2

What are the common sites for deep-vein thrombosis (DVT)?

Answer 2

DVT most commonly occurs in the deep veins of the legs or pelvis but can also affect the upper limbs, intracranial veins, and splanchnic veins.

Question 3

What are the symptoms of DVT?

Answer 3

Symptoms of DVT include unilateral localized pain, swelling, tenderness, skin changes, and/or vein distension.

Question 4

What is a pulmonary embolism (PE) and how does it occur?

Answer 4

PE occurs when a thrombus, typically from a DVT, travels to the lungs and obstructs blood flow, causing respiratory dysfunction.

Question 5

What are the symptoms of a pulmonary embolism (PE)?

Answer 5

Symptoms of PE include chest pain, shortness of breath, and/or haemoptysis.

Question 6

What is hospital-acquired venous thromboembolism (VTE)?

Answer 6

Hospital-acquired VTE refers to a VTE that develops within 90 days of hospital admission and is a common and preventable issue.

Question 7

What are common risk factors for VTE?

Answer 7

Risk factors for VTE include surgery, trauma, immobility, malignancy, obesity, hypercoagulable states, pregnancy, the postpartum period, and hormonal therapy.

Question 8

What are the two types of thromboprophylaxis?

Answer 8

The two types of thromboprophylaxis are mechanical (e.g., anti-embolism stockings, intermittent pneumatic compression) and pharmacological (e.g., heparin, rivaroxaban).

Question 9

When should mechanical thromboprophylaxis be used?

Answer 9

Mechanical thromboprophylaxis should be used when pharmacological prophylaxis is contraindicated or in certain high-risk patients, such as those with major trauma or post-surgery.

Question 10

What is the recommended thromboprophylaxis for elective hip replacement patients?

Answer 10

Elective hip replacement patients should receive low molecular weight heparin for 10 days, followed by low-dose aspirin for 28 days or a low molecular weight heparin administered for 28 days in combination with anti-embolism stockings until discharge, orrivaroxaban.

Question 11

What is the recommended thromboprophylaxis for elective knee replacement patients?

Answer 11

Elective knee replacement patients should receive low-dose aspirin for 14 days, or low molecular weight heparin with anti-embolism stockings, or rivaroxaban.

Question 12

What is the thromboprophylaxis for pregnant women at risk of VTE?

Answer 12

Pregnant women with a high risk of VTE should receive low molecular weight heparin during hospital admission and continue until discharge or no longer at risk.

Question 13

What is the treatment for suspected DVT or PE?

Answer 13

For suspected DVT or PE, start low molecular weight heparin (LMWH) until confirmed, and consider thrombolytic treatment for severe cases.

Question 14

What are the recommended anticoagulation treatments for confirmed proximal DVT or PE?

Answer 14

Offer apixaban or rivaroxaban, or use low molecular weight heparin followed by dabigatran etexilate or edoxaban.

Question 15

How long should anticoagulation treatment be continued for a confirmed proximal DVT or PE?

Answer 15

Anticoagulation should be continued for at least 3 months, or 3 to 6 months for patients with active cancer. The benefits and risks of continuing, stopping, or changing anticoagulation treatment should be assessed and discussed with the patient after this duration. - depending on provoked or unprovoked.

Question 16

What is the recommended treatment for pregnant women with VTE?

Answer 16

Pregnant women with suspected DVT or PE should receive low molecular weight heparin (LMWH) and consider compression stockings for DVT management.

Question 17

What are extracorporeal circuits used for?

Answer 17

Extracorporeal circuits are used in procedures like cardiopulmonary bypass and haemodialysis, where blood is taken from a patient, treated, and then returned. Heparin (unfractionated) is used in the maintenance of these circuits.

Question 18

What should be done if haemorrhage occurs during heparin use?

Answer 18

Usually, withdrawing unfractionated or low molecular weight heparin is sufficient, but if rapid reversal is needed, protamine sulfate is used as a specific antidote (partially reverses low molecular weight heparins).

Question 19

What are the characteristics of heparin (unfractionated)?

Answer 19

Heparin initiates anticoagulation rapidly with a short duration of action. It is also referred to as “standard” heparin to distinguish it from low molecular weight heparins and can be stopped quickly to terminate its effects.

Question 20

What are low molecular weight heparins preferred for?

Answer 20

Low molecular weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin) are preferred for preventing venous thromboembolism and are used in the treatment of DVT, PE, and clot prevention in extracorporeal circuits. They have a lower risk of heparin-induced thrombocytopenia and do not require routine monitoring.

Question 21

What is thrombocytopenia?

Answer 21

A condition that occurs when the platelet count in your blood is too low.

Question 22

What is the use of heparinoids like Danaparoid sodium?

Answer 22

Danaparoid sodium is used for prophylaxis of DVT in patients undergoing surgery and for patients with heparin-induced thrombocytopenia, provided there is no cross-reactivity.

Question 23

What is Argatroban used for?

Answer 23

Argatroban is a direct thrombin inhibitor used for the prevention and treatment of thrombosis in patients with heparin-induced thrombocytopenia type II who require parenteral anticoagulant treatment.

Question 24

What is Bivalirudin (a hirudin analogue) used for?

Answer 24

Bivalirudin is used as an anticoagulant for unstable angina, non-ST-segment elevation myocardial infarction, and patients undergoing percutaneous coronary intervention.

Question 25

What is Epoprostenol used for?

Answer 25

Epoprostenol is a potent vasodilator and platelet aggregation inhibitor used during renal dialysis when heparin is unsuitable. It is also used for primary pulmonary hypertension resistant to other treatments.

Question 26

What is Fondaparinux sodium used for?

Answer 26

Fondaparinux sodium is a synthetic pentasaccharide that inhibits activated factor X, used as an anticoagulant.

Question 27

What are the two main types of strokes and what causes them?

Answer 27

Ischaemic stroke: Caused by infarction following vascular occlusion or stenosis. Haemorrhagic stroke: Caused by a focal collection of blood within the brain or ventricular system.

Question 28

What is a transient ischaemic attack (TIA)?

Answer 28

A TIA is a transient neurological dysfunction (less than 24 hours) caused by focal brain, spinal cord, or retinal ischemia without evidence of acute infarction.

Question 29

How should a patient presenting with a TIA be managed initially?

Answer 29

Aspirin 300 mg should be given immediately unless contraindicated, and the patient should be referred for specialist assessment within 24 hours.

Question 30

When should dual antiplatelet therapy with clopidogrel and aspirin be considered?

Answer 30

For patients with TIA or minor stroke within 24 hours who have a low risk of bleeding.

Question 31

What are the symptoms that suggest a TIA or stroke?

Answer 31

Sudden onset of focal neurological deficits, such as numbness, weakness, slurred speech, or visual disturbances. TIA resolves within 24 hours, usually within an hour, while stroke symptoms persist for longer than 24 hours.

Question 32

What should be done before starting anticoagulation or antiplatelet treatment in someone with suspected ischaemic stroke?

Answer 32

Intracerebral haemorrhage should be excluded by brain imaging.

Question 33

What is the first-line treatment for an acute ischaemic stroke if administered within 4.5 hours?

Answer 33

Alteplase or tenecteplase, provided intracranial haemorrhage has been excluded.

Question 34

When is warfarin or direct thrombin/factor Xa inhibitors recommended in stroke patients?

Answer 34

In patients with ischaemic stroke or TIA AND paroxysmal, persistent, or permanent atrial fibrillation or atrial flutter once intracranial bleeding and other contraindications have been excluded.

Question 35

What is the recommended long-term treatment for patients with ischaemic stroke or TIA who do not have atrial fibrillation?

Answer 35

Clopidogrel 75 mg daily, or if intolerant, aspirin with modified-release dipyridamole.

Question 36

What are the considerations for managing blood pressure in acute ischaemic stroke?

Answer 36

Blood pressure should only be lowered in the event of a hypertensive emergency or in patients considered for thrombolysis. Otherwise, it should be carefully managed to avoid reducing cerebral perfusion.

Question 37

What is the management strategy for intracerebral haemorrhage?

Answer 37

Surgical intervention may be necessary, and rapid blood pressure lowering may be considered in specific cases. Anticoagulants should be stopped and reversed.

Question 38

What is the target INR range for warfarin therapy in patients with atrial fibrillation after a stroke?

Answer 38

The target INR range is 2.0 to 3.0.