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IPC CARDIOLOGY 2 JEN > Venous Thromboembolism (VTE) Prophylaxis > Flashcards

Venous Thromboembolism (VTE) Prophylaxis Flashcards

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1
Q

What is VTE?

A

a clot occurring in the VENOUS circulation

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2
Q

Two types of VTE

A

Deep Vein Thrombosis (DVT)
Pulmonary Embolism (PE)

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3
Q

**FIRST SET OF CARDS HAS VICHOWS TRIAD, RISK FACTORS, DVT vs PE, THROMBUS, EMBOLISM but still pertains to this **

A

**FIRST SET OF CARDS HAS VICHOWS TRIAD, RISK FACTORS, DVT vs PE, THROMBUS, EMBOLISM but still pertains to this **

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4
Q

Platelet Cascade:

A

Platelet activation, platelet adhesion, platelet aggregation

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5
Q

Treat Platelet cascade (activation, adhesion, aggregation) with…

A

Antiplatelets

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6
Q

Arterial Clots include…

A

CAD, PAD, Strokes

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7
Q

The clotting cascade… treat with

A

anticoagulants

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8
Q

Venous clots include…

A

DVT, PE

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9
Q

VTE Prophylaxis treatment goal…

A

Prevent VTE from occuring in patients at high risk (usually hospitalized patients)

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10
Q

VTE Prophylaxis treatment

A

low dose anticoagulation, AND/OR mechanical prophylaxis

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11
Q

For VTE Hospitalized patients which score do we use?

A

PADUA score
MAGIC NUMBER 4

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12
Q

Padua score <4 …

A

low risk of VTE, generally does not require thromboprophylaxis

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13
Q

Padua score >4…

A

thromboprophylaxis is recommended for non-pregnant patients without contraindications (major bleeding, low platelets) who are over 18 years old

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14
Q

Which risk factors of Padua score are 3 points

A

Active cancer, previous VTE, reduced mobility, known genetic hypercoaguable condition

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15
Q

Which risk factors of Padua score are 2 points

A

recent trauma/surgery (within 1 month)

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16
Q

Which risk factors of Padua score are 1 point

A

> 70 years old, cardiac or respiratory failure, acute MI or ischemic stroke, acute infection or rheumatologic disorder, obesity (BMI > 30), hormonal treatment

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17
Q

Nonpharmacologic treatment options for VTE

A

Ambulation, Graduated Compression Stockings, Sequential Compression Devices (SCDs), Inferior vena cava filter

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18
Q

What is the Nonpharmacologic GOLD STANDARD treatment

A

Ambulation

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19
Q

Pharmacologic Treatment options HEPARIN DOSING VTE

A

5000 units Q8-12H
(much lower doses than the full therapeutic dosing)

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20
Q

Pharmacologic Treatment options LMWH DOSING VTE

A

30 units BID OR 40 units daily
(much lower doses than the full therapeutic dosing)

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21
Q

Malignancy treatment only applies to…

A

OUTPATIENTS

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22
Q

Malignancy treatment: Int-High Strong

A

Routine pharmacologic thromboprophylaxis SHOULD NOT be offered to all outpatients with cancer

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23
Q

Malignancy treatment: Int-High Moderate

A

High-risk outpatients with cancer (Khorana score >2) may be offered thromboprophylaxis with APIXABAN, RIVAROXABAN, LMWH, provided there are no significant risk factors for bleeding and no drug interactions

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24
Q

Malignancy treatment: Intermediate, Strong

A

Patients with MULTIPLE MYELOMA receiving THALIDOMIDE or LENALIDMIDE BASED REGIMENS with chemotherapy and/or dexamethasone should be offered pharmacologic thromboprophylaxis with either ASPIRIN or LMWH for lower risk patients and LMWH for higher risk patients

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25
Khorana score: 2 points
Site of cancer: stomach, pancreas
26
Khorana score: 1 point
-Site of cancer: lung, lymphoma, gynecologic, bladder, testicular, renal -Prechemotherapy platelet count ≥ 350,000 -Hemoglobin < 10 g/dL or use red cell growth factors -Prechemotherapy leukocyte count > 11,000 -BMI ≥ 35
27
We care about distal vs proximal DVT because...
this may change whether we treat a patient or not
28
Bleed Risk Assessment Risk factors
Will be given we just need to calculate score
29
How to calculate Bleed Risk Assessment Risk factors
Low risk= 0 factors Moderate risk= 1 Risk factor High risk= >2 risk factors
30
Distal DVT (below the knee) In patients with acute isolated distal DVT in the leg...
we suggest SERIAL IMAGING OF THE DEEP VEINS FOR 2 WEEKS unless there are with severe symptoms or risk factors for extension, then we can suggest anticoagulation
31
In patients managed with anticoagulation, we recommend...
using the same anticoagulation as for patients with acute proximal DVT
32
In patients with acute isolated distal DVT of the leg who are managed with serial imaging we recommend...
NO ANTICOAGULATION IF THE THROMBUS DOES NOT EXTEND, SUGGEST ANTICOAGULATION IF THE THROMBUS EXTENDS
33
In patients with cancer: High, strong strength of evidence with INITIAL ANTICOAGULATION and VTE the recommendation may involve...
Initial anticoagulation: may involve LMWH, UFH, fondaparinux, rivaroxaban, or apixaban.
34
For patients initiating treatment with parenteral anticoagulation what is preferred?
LMWH is preferred over UFH for the initial 5-10 days
35
In patients with cancer: High, strong strength of evidence and LONG TERM ANTICOAGULATION and VTE the recommendation may involve...
LMWH, edoxaban, or rivaroxaban for at least 6 months are preferred because of improved efficacy over vitamin K antagonists (VKAs). There is an increase in major bleeding risk with DOAC's, particularly observed in GI and potentially genitourinary malignancies
36
In patients with cancer: Low, weak-moderate strength of evidence and and VTE the recommendation may involve...
Anticoagulation beyond the initial 6 months should be offered to select patients with active cancer, such as those with metastatic disease or those receiving chemotherapy
37
PE Treatment based on Classification: Low risk
Therapeutic anticoagulation
38
PE Treatment based on Classification: Intermediate risk
Anticoagulation, thrombectomy or catheter-directed thrombolytics, then therapeutic anticoagulation
39
PE Treatment based on Classification: high risk
IV thrombolytics then therapeutic anticoagulation
40
Plasminogen is present in the blood stream, but it is also bound to fibrin clots...when it is bound it......
stabilizes the clot
41
Active plasminogen is called...
plasmin
42
Plasmin degrades...
fibrin clots
43
Thrombolytics activate ______
plasminogen --> plasmin and degrades the fibrin clots
44
Alteplase fibrin specificity
non specific
45
Alteplase half life
5 minutes
46
Tenecteplase half life
90-130 minutes
47
Alteplase dosing
bolus followed by infusion
48
Tenecteplase fibrin specifity
specific to clot bound fibrin
49
Medications used for CDT...
Heparin, Alteplase
49
Tenecteplase dosing
1 bolus
50
Catheter Directed Thrombolytics (CDT) are used to...
break up clots there are holes in the catheter to do this
51
Types of CDT
Unifuse and EKOS
52
What is Unifuse
Without ultrasound
53
What is EKOS
EkoSonic Endovascular System With ultrasound Device to deliver catheter directed thrombolytics + ultrasound waves
54
EKOS may be ______ effective at breaking up clots than _____
MORE, CDT alone
55
In patients with VTE and no cancer we suggest...
Dabigatran, rivaroxaban, apixaban, or enoxaban over vitamin K antagonist (VKA) therapy
56
For patients with VTE and no cancer who are not treated with Dabigatran, rivaroxaban, apixaban, or enoxaban we suggest...
VKA therapy over LMWH
57
In patients with an unprovoked proximal DVT or PE who are STOPPING ANTICOAGULANT THERAPY it is suggested to take....
Aspirin to prevent recurrent DVT (unless there is a contraindication to it)
58
In patients with proximal DVT or PE take...
3 months of anticoagulant therapy
59
In patients with UNPROVOKED VTE: Low-moderate bleeding risk:
Extended anticoagulant therapy (no scheduled stop date)
60
In patients with UNPROVOKED VTE: High bleeding risk:
3 months of anticoagulant therapy
61
In patients with DVT of the leg or PE and ACTIVE CANCER it is recommended...
to extend anticoagulant therapy (no scheduled stop date)

IPC CARDIOLOGY 2 JEN (6 decks)

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