Thrombolytic Agents Flashcards
What population is most affected by thromboembolic events?
neonates; most affected age group with an incidence of 41:100k per year
What are indications for prophylaxis thrombolytic agent use in children?
central venous catheters, prosthetic heart valves, blalock-taussig shunt, endovascular stents, fontan procedure, atrial fibrillation, continuous arteriovenous hemofiltration, hemodialysis, ECMO and kawasaki dz
What are indications for treatment with thrombolytic agent use in children?
DVT, PE, arterial thromboembolism, venous thromboembolism and nonhemorrhagic stroke
what are the typical events in the NICU requiring intervention by a thromblytic agent?
catheter does not function, cannot infuse/draw from line; less commonly, thromboembolic phenomenon is due to an inherited or acquired thrombophilia
what is an example of an inherited thrombophilia disease state?
heterozygous factor V protein C or protein S deficiency
what is an example of an acquired thrombophilia disease state?
CMV is a rare cause of neonatal aortic thrombosis
what is the definition of a thrombus?
a BLOOD CLOT formation in an artery or vein. this clot formation can cause partial or complete obstruction
what is the definition of an embolus?
a clot that is MOBILE and lodges in a blood vessel. this may cause obstruction or vasospasm
what is the definition of a vasospasm?
a muscular contraction of an arterial vessel. cardinal sign: COLOR ∆ in the affected extremity
What are the characteristics of color ∆ accompanying vasospasm?
color ∆ is blue or white; may extend to buttocks or abdomen; ∆ may be transient of persistent
what can induce color ∆ and vasospasm?
prior injection of medication, a manifestation of a thromboembolism or thromboembolitic phenomena
what can be a predisposing factor to vasospasm?
arterial blood sampling
what is a cause of venous thrombosis?
indwelling venous catheters or renal vein thrombosis
what are the signs and symptoms a/w a venous thrombosis?
the extremities are swollen, discolored, superificial veins are distended
what are the signs and symptoms a/w renal venous thrombosis?
hematuria, HTN, thrombocytopenia and/or a flank mass
If a pt p/w absent pulses, what diagnosis should you consider?
aortic thrombosis
what are the signs and symptoms a/w an arterial thrombosis?
decreased perfusion and color ∆ of the lower extremities, loss of pulses, blood pressure difference between UE and LE, oliguria, HTN and hematuria
What is aortic thrombosis with absent arterial pulses considered?
a medical emergency
what labs are indicated for a suspected thromboembolic w/u?
thrombin time, PTT, PT/INR, PCV (hct), Plt count, Fibrinogen, genetic tests and CMV r/o
what is the most common diagnostic study used?
US; can be unreliable (underestimates # of art/ven throbuses and has a significant # of false positives)
when is an US a helpful tool?
to monitor progress of thrombus over time
what is the gold standard diagnostic study used?
angiography; performed via umbi line
When is a total w/u indicated?
when a thrombus is suspected and dissolving medication used; not necessary in the presence of an independent vasospasm
what are the general guidelines in the treatment of a thromboembolic event?
prompt removal of offending catheter (take access into account), tx vol depletion, replete electrolyte abnormalities, sepsis, thrombocytopenia and anemia; evaluate for IVH; s/p major surgery w/i 10d; investigate for other causes of increased bleeding (GI, pulm, intercranial, etc..); anticoag and thromobolytic tx is NOT recommended in these circumstances
