Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

X Clin Med Final > Venous Thromboembolism > Flashcards

Venous Thromboembolism Flashcards

(64 cards)

Start Studying
1
Q

What are the most common presentations of venous thrombosis?

A

Deep vein thrombosis or pulmonary embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Virchow’s triad?

A

Stasis (alterations in blood flow so that the blood is sitting there ready to coagulate), vessel wall injury and hypercoagulability (alterations in constituents of blood either inherited or acquired) cause thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a MAJOR risk factor for recurrent VTE?

A

Previous thrombotic event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chronic conditions that are acquired risk factors of VTE

A

Malignancy, antiphospholipid antibody syndrome, myeloproliferative disorders

Chronic diseases, obesity, advanced age, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Transient states that are acquired risk factors of VTE

A

Surgery, trauma, immobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Female specific acquired risk factors of VTE

A

Pregnancy, hormonal contraceptives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Inherited risk factors of VTE

A

Factor V Leiden mutation of prothrombin gene mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the classic symptoms of a DVT?

A

Swelling, pain and erythema of the involved extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most useful finding for a DVT?

A

Larger calf diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Wells scoring for DVT

A 
Paralysis/orthopedic casting
Bedridden/major surgery within 4 wks
Localized tenderness
Swelling of leg
Calf swelling
Pitting edema
Collateral non varicose superficial veins
Active cancer/ or last 6 mos
Alternate diagnosis more likely (-2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do you do after calculating pretest probability and they have a low or moderate probability of a DVT?

A

Do a serum D-dimer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a serum D-dimer?

A

Degradation product of cross-linked fibrin (clots)
Detectable at levels higher than 500 ng/mL in almost all VTE pts (use ELISA)
Sensitive but not specific for DVT so only useful when NEGATIVE (and low probability because then they don’t have it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the other diagnostic tests for DVT?

A

Contrast venography
Impedance plethysmography
Compression ultrasound**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What do you see on compression ultrasound in a DVT?

A

Loss of vein compressibility because the clot is in the way

Doppler assesses blood flow to the given region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do you need to treat a DVT?

A

Always for proximal DVTs (popliteal, femoral, iliac) because secondary to risk of PE and death
Appropriate for many distal DVTs especially when they have sxs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the purpose of DVT treatment?

A

Prevent further clot propagation
Prevent PE
Decrease risk of recurrent VTE
Decrease complications (post-thrombophlebitic syndrome caused by chronic venous insufficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the mainstay of DVT therapy?

A

Anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Initial anticoagulation therapy for DVT

A

0-10 days is the period of highest risk for recurrent thrombosis or embolization so this tx is for that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the minimum amt of time for anticoagulation therapy?

A

3 months (long term but finite)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What else is recommended in the tx of DVT?

A

Early ambulation for fully anticoagulated, hemodynamically stable and pts whose sxs are under control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are elastic graduated compression stockings used for?

A

Prevention of post thrombotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of upper extremity DVT

A

Spontaneous

Secondary (more common) to catheter placement of prothrombotic states

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is superficial thrombophlebitis?

A

Not a DVT but usually caused by a peripherally inserted IV into a small vein
Tx with local heat and NSAIDs and usually goes away in 1-2 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What material can cause a pulmonary embolism?

A

Thrombus, tumor, air or fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the most common cause of pulmonary embolism?
DVT (mostly proximal, isolated calf DVT is much less frequent)
26
How are PEs classified?
Presence or absence of hemodynamic stability (is it causing severe vascular problems?) Temporal pattern of presentation (acute, subacute or chronic) Anatomic location (saddle-where pulm Ar splits, lobar, segmental, subsegmental) Presence or absence of sxs
27
What is another name for a hemodynamically instable PE?
Massive PE! | Systolic BP <90 mmHg or drop of SBP of over 40 from baseline for more than 15 min
28
Common symptoms of PE
Dyspnea, pleuritic pain, cough and sxs of a DVT | Also tachypnea and dacycardia
29
What is the difference in diagnosis between hemodynamically stable and unstable pts?
Stable: Wells criteria, D-dimer and CTPA Unstable: cannot do definitive imaging so need bedside echocardiography to get presumptive diagnosis (see a collapse/abnormality of right ventricle)
30
What is the test of choice for diagnosis of a PE?
CT pulmonary angiogram
31
What are additional tests for PE?
VQ scan, contrast pulm angiography, serial lower extremity u/s, magnetic resonance pulm angiography
32
When is CT pulmonary angiography most accurate?
For detection of large, main, lobar and segmental PEs
33
When can you not use CTPA?
IV contrast allergy or renal dysfunction
34
VQ scanning
Sensitive test for PE but poorly specific because of false-positives Can be interpreted as "intermediate probablity" and then you can't do much with that Most commonly used when pts can't do CTPA
35
When is VQ scanning easiest to interpret?
When pt has a normal chest radiograph
36
What is the most common findings/classic finding of PE?
Nonspecific ST-segment and T wave changes | Classic: S1Q3T3 pattern with right ventricular strain
37
What can you see on a chest x ray in PE?
Hamptom's hump: opacity from infarct | Westermark sign: oligemia (low BF)
38
What is the PERC rule?
PE rule out criteria as alternate to further testing in low prob assesment for PE Age <50, HR<100, oxyhemoglobin saturation >95, no hemoptysis, no estrogen use, no prior DVT/PE, no unilateral leg swelling, no surgery/trauma with hospitalization in last 4 weeks If fulfill all 8, no further testing
39
What is the treatment for PE?
Supportive: supplement O2, mechanical ventilation if needed, vasopressors to maintain BP Anticoagulation And other things
40
What are the options for VTE anticoagulants?
IV unfractionated heparin (not usually for a stable person) SQ LMWH (Lovenox) Oral Warfarin (Coumadin) Factor Xa inhibitors (fondspusrinux-Arixtra, Xarelto, Eliquis, Savaysa, Lixiana) Oral direct thrombin inhibitors (Pradaxa)
41
What anticoagulant is best for pts with renal failure, hemodynamically instability or massive iliofemoral DVT?
IV UFH (because need rapid reversal)
42
What is the anticoagulant of choice in pregnancy or active cancer?
LMWH
43
Why do you not want to interrupt tx in the first 3 months?
There is a high risk of recurrent thrombosis
44
What is the traditional long term therapy?
Warfarin (monitor with prothrombin time and international normalized ratio)
45
What are the best choices for tx when the patient does not want to do INR monitoring?
Oral factor Xa inhibitors and oral direct thrombin inhibitors
46
What is the anticoagulation reversal for UFH?
Protamine
47
What is the anticoagulation reversal for LMWH?
Protamine (usually incomplete reversal tho)
48
What is the anticoagulation reversal for warfarin?
Vitamin K and fresh frozen plasma
49
What is the anticoagulation reversal for factor Xa inhibitors?
Andexanet alfa
50
What is the anticoagulation reversal for direct thrombin inhibitor?
Dabigatran (idarucizumab)
51
What are some general anticoagulation reversals?
Activated prothrombin complex concentrate, antifibrinolytic agents (transexamic acid), hemodialysis, activated charcoal
52
What is the duration of therapy for an unprovoked clot?
Extended unless high risk of bleeding (6-12 mos)
53
When do you consider indefinite anticoagulation?
Pts with underlying thrombophilia or active malignancy
54
What should people with a VTE before 45 and have at least one 1 degree relative with a VTE be tested for?
All 5 inherited thrombotic disorders (antithrombin def, protein s and c def, factor V leiden and prothrombin gene mutation) AND Antiphospholipid syndrome
55
When would you consider and IVC filter?
Anti coagulation is contraindicated Risk of bleeding outweighs risk of recurrent VTE Recurrent PE despite adequate anticoagulation Complication of anticoagulation like severe bleeding Hemodynamic or respiratory compromise so that another PE may be life threatening
56
What do thrombolytics do?
Activate plasminogen to form plasmin which results in an accelerated lysis of the thrombi- clot buster BUT it might burst arteries in the brain
57
When are thrombolytics indicated?
Unstable pt with a PE (massive PE and sustained hypotension with cardiogenic shock)
58
When do you use thromectomy/embolectomy?
Hemodynamically unstable PE when thrombolytic therapy is contraindicated or they failed thrombolysis
59
What is another helpful VTE deterrent?
Early ambulation
60
What are some mechanical prophylactic measures for hospitalized pts?
Intermittent pneumatic compression and thromboembolitic deterrent hose
61
What prophylatic measures are used in admitted pts with no risk factors?
Mechanical prophylaxis
62
What prophylatic measures are used in admitted pts with 1 risk factor and no increased risk of bleeding?
Pharmacological prophylaxis- low dose subQ heparin (Lovenox) at 40 mg a day
63
What prophylatic measures are used in admitted pts with multiple risk factors for VTE?
Mechanical and pharmacological prophylaxis
64
What must a pt be able to do if they are not admitted for their tx of a VTE?
Have their pain controlled Be able to administer injections if needed Have the ability to pay for injections when transitioning to oral warfarin Be compliant

X Clin Med Final (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions