VTE

Question 1

What are the two most common thrombophilia’s found in patients with VTE

Answer 1

Factor five Leiden (most common inherited thrombophilia, causes activated protein C resistance). Carrier rate5%

and prothrombin gene mutation

Question 2

Which thrombophilia cannot be tested for during pregnancy?

Which thrombophilia cannot be tested for during acute thrombosis or while the patient is anticoagulated?

Answer 2

Activated protein C resistance assay for FVL, protein S

Proteins C and protein S deficiency, anti-thrombin 3 def

Question 3

What are the clinical criteria for antiphospholipid antibody syndrome yes

Answer 3

1. Arterial or venous thrombosis
2. Pregnancy morbidity consisting of one of the following:
   - death of morphologically normal fetus at or beyond 10 weeks
   - premature birth before34 weeks due to severe preeclampsia or eclampsia
   - > or = 3 consecutive SAB before 10w

Question 4

How is low molecular weight heparin monitored?

Answer 4

Anti-factor Xa level, 0.6-1, 4 hrs after injection

Question 5

Virchow’s triad

Answer 5

Hypercoagulable state
Venous stasis
Endothelial damage

Question 6

Treatment dosing for heparin

Answer 6

80u/kg load (max 10000)

18u/kg/kg/hr

PTT should be1.5-2.5xnormal

** does not work for ATIII DEF**

Question 7

Treatment dosing for Lovenox

Answer 7

1 mg/kg BID OR

1.5 mg/kg once daily

Question 8

Neonatal effect of homozygous protein c or s

Answer 8

Neonatal purpura fulminans

|&raquo_space;DIC and hemorrhagic skin necrosis

Question 9

When is testing indicated for inherited thrombophilas?

Answer 9

Personal hx of VTE

1st def relative with high risk thrombophilia

Question 10

High risk thrombophilias

Answer 10

FVL homozygote
Prothrombin homozygote
Antithrombin def
FVL and prothrombin heterozygote

Question 11

How long to hold anticoagulation before epidural?

Answer 11

LMWH,
ppx dose, 12 hrs
Adjusted dose 24h

UFH
>7500u, 12 hrs and check aPTT

Question 12

Prophylactic dosing for
LNWH
UFH

Answer 12

40mg SC daily

5000-7500u SC q12h first tri
7500-1000u SC q12 2nd tri
10k SC q12 3rd tri

Question 13

Intermediate dose LMWH

Answer 13

40mg SC Q12h

Question 14

Adjusted dose
LMWH
UFH

Answer 14

1mg/kg q12h w target anti Xa level 0.6-1.0 4 hrs after injection

10ku SC q 12 titration to aPTT 1.5-2.5x nml 6 hrs after injection

Question 15

When to restart anticoagulation after
Vag del
CD

Answer 15

6h

12h

Question 16

When to restart anticoagulation after epidural catheter removal?

UFH
LMWH

Answer 16

1h

4h

Question 17

Obstetric complications associated with antiphospholipid antibodies

Answer 17

Pre-e
IUGR
PTB
PLACENTAL INSUFF
Thrombocytopenia

Question 18

Treatment for women with recurrent pregnancy loss and antiphospholipid antibody

Answer 18

Ppx heparin
ASA 81 mg

Pregnancy and 6 weeks PP

Question 19

How does warfarin work?

Antidote?

Answer 19

Inhibits factors 2,7,9,10
Vitamin k antagonist

Vitamin K

Question 20

Which inherited thrombophlilias require anticoagulation antepartum?

Answer 20

FVL homozygote
Antithrombin 3
Prothrombin homozygote
Prothrombin and FVL heterozygous combination

Question 21

Risk factors for DVT

Answer 21

Age greater than 40
Surgery for malignancy
Prolonged surgery greater than 30 minutes
Obesity
Delayed postoperative ambulation
Medical comorbidities such as diabetes, heart failure, COPD
Varicose veins