Venous Thromboembolism

Question 1

DVT presentation?

Answer 1

(U) asymp
swelling, pain, warm, red

Palpable cord and/or difference >3 cm b/w legs = bad

Question 2

DVT physical exam components? (6)

Answer 2

Vascular
Extremities
Lungs
Cardiac
Abdominal
Skin

Question 3

DVT Wells Score?

Answer 3

probability of DVT: High = >=3 aggravators

CA, bedridden, swelling, etc: each get point

Question 4

DVT labs? (5)

Answer 4

CBC w/ platelets
Coag: PT/INR, aPTT
Metabolic Panels: renal and liver
UA
D-dimer

Question 5

High D-dimers (from fibrin clots) caused by what conditions?

Answer 5

DVT/PE
Post-op
Malignancy
Pregnancy

Question 6

DVT diagnostic tests?

Answer 6

*Compression US = loss of vein compressibility

Contrast Venography

Question 7

DVT testing algorithm

Answer 7

If high risk and US = abn -> positive DVT

If US = normal -> do venography
If veno = normal -> no DVT
If veno = abn -> + DVT

Question 8

DVT tx

Answer 8

Prevent clot propagation and PE

Question 9

UE DVT etiology?

Answer 9

spontaneous: thoracic outlet synd

2º: catheter, prothrombic states

Question 10

UE DVT tx?

Answer 10

anticoag
thrombolysis
surgical decompression

Question 11

DVT vs Superficial Thrombophlebitis (STP) cause?

Answer 11

DVT: Virchow’s Triad (stasis, vascular injury, hypercoag)

STP: venous cath/line, pregnancy, trauma, hypercoag

Question 12

DVT vs Superficial Thrombophlebitis (STP) presentation?

Answer 12

DVT: swelling

STP: swelling uncommon

Question 13

DVT vs Superficial Thrombophlebitis (STP) tx?

Answer 13

DVT: anticoag

STP: Ø anticoag, local heat, NSAIDS

Question 14

PE definition?

Answer 14

pulmonary artery or branch obstruction from material originating elsewhere

Question 15

PE (U) caused by?

Answer 15

DVT (U) proximal, rarely from calf DVT

Question 16

Massive vs Submassive PE?

Answer 16

Massive: a/w SBP < 90 or ↓ >= 40 for > 15min;
NOT explained by hypovolemia, sepsis, MI, pneumothorax, new arrhythmia,
results in RV failure

Submassive: all others

Question 17

PE sxs? (6)

Answer 17

dyspnea
pleuritic pain
calf/thigh pain/swelling
cough
orthopnea
wheezing

Question 18

PE signs?

Answer 18

tachypnea
tachycardia
rales
↓ breath sounds
↑ S2
JVD
LE DVT sxs

Question 19

PIOPED II says most common sign and sx of PE are?

Answer 19

dyspnea

tachypnea

Question 20

PE prediction

Answer 20

Wells for DVT >4 = PE likely

Question 21

PE physical eval?

Answer 21

Vital signs
general exam (BP, HR, RR, mental status)

Question 22

PE labs?

Answer 22

same as DVT

(P) thrombin, BNP

Question 23

PE gold stand test?

Answer 23

pulmonary angiography:
highly specific/sensitive

disadv: invasive, contrast, expensive

Question 24

VTE tx strategies? (5)

Answer 24

1) Anticoag
2) Thrombolytics
3) Thromectomy
4) IVC filter
5) Prophylactics

Question 25

Anticoag meds? (6)

Answer 25

1) IV unfractionated Heparin 2) Low MW Heparin 3) Warfarin 4) Fondaparinux 5) Factor Xa Inhibitors 6) Direct Thrombin Inhibitors

Question 26

IV Unfractionated Heparin: indication action

Answer 26

Initial tx of VTE Inactivates thrombin, potentiates antithrombin

Question 27

Low MW Heparin: indication action

Answer 27

outpt DVT and stable PE tx Inhibits Factor Xa

Question 28

Warfarin: indication action

Answer 28

long term VTE tx blocks vit K-dependent coag proteins in liver

Question 29

Duration of Anticoag for: major transient risk? minor transient risk?

Answer 29

3 months for either

Question 30

Duration of Anticoag for: cancer? unprovoked thrombosis? underlying thrombophilia?

Answer 30

CA = 3-6 mo or while CA active unprovoked = 3 mo thrombophilia = indefinite, test 3 mo post event

Question 31

Thrombolytics: indication action

Answer 31

unstable PE activates plasminogen to make plasmin -> accelerates lysis of thrombi

Question 32

IVC Filters are/do?

Answer 32

filter placed in IVC, | stops clot from moving to lungs

Question 33

IVC Filter indication? Contraindication?

Answer 33

recurrent PE despite anticoag complications to anticoag hemo or respiratory compromise contraindicated w/ anticoag

Question 34

Prophylactics for DVT in hospital?

Answer 34

TED hose, Sequential compression Heparin low-dose, Lovenox

Question 35

Outpt tx of DVT if? (6)

Answer 35

``` ambulatory and stable normal vitals low bleeding risk no renal insuff LMWH/warfarin w/ monitoring bleed and VTE monitoring ```