VENOUS THROMBOEMBOLISM Flashcards
What are the two types of Venous Thromboembolism?
Pulmonary Embolism - blockage of artery in the lungs
Deep Vein Thrombosis - blood clot in the body, usually legs
What is the treatment for Venous Thromboembolism?
- Antiplatelets - aspirin, clopidogrel etc
- Anticoagulants - warfarin, apixaban etc
- Thrombolytics - alteplase
Who must be assessed for risk of VTE?
ALL patients admitted to hospital have to be assessed for their risk of VTE on admission
Which patients are in high risk of VTE?
- Substantial reduction in mobility
- Obesity
- Malignant disease
- History of VTE
- Thrombolytic disorder
- Patients over 60 years of age
When should mechanical and pharmacological prophylaxis be given?
Mechanical prophylaxis - to patients due for surgery and continue until patient is mobile
Pharmacological prophylaxis - to patients undergoing orthopaedic surgery who are high risk
Which drugs are given for VTE Prophylaxis?
- Offer fondaparinux sodium to patients undergoing hip or knee surgery, bariatric surgery, or day surgery procedures
- Offer oral anticoagulants for thromboembolism prophylaxis following hip/knee surgery.
How long should pharmacological prophylaxis be given for?
Until the patient is mobile
What kind of heparin is preferred in patients with renal failure?
Unfractionated heparin
What kind of heparin can be used used in all types of general and orthopaedic surgery?
Low weight molecular heparins (LWMH)
What should be given for the initial treatment of VTE?
- Use LWMH (such enoxaparin, dalteparin, tinzaparin) for the initial treatment.
Unfractionated heparin can be used as an alternative
- Start oral anticoagulant (usually warfarin) at the same time as heparin.
Can heparins be taken when pregnant?
Heparins are safe in pregnancy as they do not cross the placenta.
However LWMH is preferred as it carries a lower risk of osteoporosis.
But they are eliminated more rapidly in pregnancy so a dose alteration is required
What should be done in VTE if a haemorrhage occurs?
Withdraw the heparin.
What can be used to reverse the effects of heparin?
Protamine sulphate.
But it only partially reverses the effects of LWMH.
What’s the mechanism of action for Tranexamic acid?
Inhibits fibrinolysis
What is Tranexamic acid used for?
- To prevent bleeding (eg surgery)
- To manage menorrhagia
