Venous Thromboemolisms Flashcards
(26 cards)
What is venous thromboembolism prophylaxis?
All patients admitted to hospital need to be assessed for their risk of VTE and bleeding on admission
Who are patients at risk of of VTE?
Decreased mobility
Obesity and overweight
Malignant disease
History of previous VTE
Thrombophillic disorder
Pregnancy
Dehydration
HRT+ Combined hormonal contraception + oestrogen contraception
Patients over 60 years old
What are the two types of prophylaxis?
Mechanical and pharmacological
What’s the pharmacological prophylaxis?
LMWH
Unfractionated heparin
Fondaparinux sodium
DOACS
What is used for the treatment of DVT or PE
1ST LINE = Confirmed DVT or PE - Rivaroxaban or Apixaban
Alternative = LMWH + (Dabigatran/edoxaban)
What do we use for prophylaxis?
We usually offer either mechanical or pharmacological prophylaxis
What’s used for mechanical?
For patients that are due for surgery
Don’t offer stockings to patients that have acute stroke,peripheral arterial disease,peripheral neuropathy, severe leg odemas or local conditions like dermatitis or gangrene
Offer pharmacological prophylaxis to
Patients undergoing general or orthopaedic surgery - when the risk of VTE outweighs the risk of bleeding
Start pharmacological prophylaxis as soon as possible or within 14 hours of admission, LMWH are suitable in all types of general and orthopaedic surgeries
Who is unfractionated heparin preferred in?
Patients that are renally impaired or those at a high risk of bleeding
VTE prophylaxis in surgery
Fondaparinux sodium - to patients undergoing hip,knee surgery, bariatric suregry or day suregry
What’s an important thing to remember about pharma prophylaxis in general surgery?
Should continue for at least 7 days post surgery or until the patient is mobile
LMWH - used in which types of surgeries?
All types of general and orthopaedic surgery
Heparins (unfractionated) are preferred in which surgeries?
Patients with renal impairment, crack 15-50 ml/min or have an increased bleeding risk
Fondaparinux sodium is preferred with who?
Abdominal,bariatric surgery,thoracic surgery, cardiac or patients with lower limb immobility or fractures of pelvis or hip or proximal femur
DOACS are given to which suregeries
Elective knee, hip replacement surgery after LMWH or low dose aspirin
What is the first line treatment for confirmed DVT/PE (R.A.P.E)
Rivaroxaban or Apixaban for PE or DVT
Alternative LED to treatment of confirmed DVT or PE
Low molecular weight heparin for at least 5 days followed by Dabigatran or edoxaban
For renally impaired patients with a circle of 15-50 ml/min what can we offer them?
Apixaban
Rivaroxaban
LMWH for at least 5 days followed by dabigatran if their crcl is more than 30 ml/min or edoxaban
Treatment of VTE in pregnancy
LMWH or unfractionated heparins can be used as they don’t cross the placenta
LMWH Preferred (Lower risk of osteoporosis and heparin induced thrombocytopenia -low platelets
LMWH (Dalteparin,enoxaparin,tinzaparin) are eliminated more in pregnancy so a dose adjustment is needed
Duration of anticoagulation treatment - For confirmed proximal DVT or PE
At least 3 month (3-6 for active cancer)
Duration of anticoagulation treatment -provoked DVT and pulmonary embolism ( eg. Pregnancy or contraceptive)
3 months or (3-6 months for active cancer)
Unprovoked DVT or PE
More than 3 months (or more than 3 months for active cancer)
Duration of treatment + long term anticoagulation for secondary prevention:
Patients with confirmed DVT and PE = offer anticoagulant treatment for at least 3 months (3-6 months in active cancer)
What do we do for proximal DVT (located in femoral - thigh,iliac abdomen veins, isolated DVT below the knee and calf)
Offer confirmed treatment with anticoagulant used for the initial treatment, if it is well tolerated consider switching to Apixaban if their current treatment is a DOAC
Consider aspirin for patients that decline anticoagulant treatment
