VTE Flashcards
(50 cards)
What happens in the body in VTE (DVT & PE)
DVT - a blood clot forms in the deep veins
PE - ^ that blood clot breaks off and travels to the right side of the heart and the right ventricles pumps it into the pulmonary artery
Risk factors
Long haul flights
Cancer
Hormone treatment
60+
hx of DVT
Varicose veins
Smoking
Obesity
HF
DVT features
Throbbing in 1 leg - thigh or claf
Red, warm skin
Swelling
Pitting odema
PE features
Pluretic chest pain
Cynosis
Difficulty breathing
Tachycardia
VTE provoking factors
(Not all VTEs are provoked only 50%)
Pregnancy
HRT/pill
Immobility
Surgery/trauma
What wells score indicates DVT
2 and over
What test do you do if DVT is likely
Offer leg ultrasound within 4 hours
If not possible then do a d dimer test and anticoagulate & arrange a scan within 24 hours
What we’ll score indicates that DVT is not likely
And what’s test would you do
Do d dimer test
• positive then arrange ultrasound
• negative- do not anticoagulate
What we’ll score indicates that PE is likely
Over 4
What test to offer is PE is likely
CT pulmonary angiography - CTPA
What we’ll score indicates that PE is not likely?
4 and under
What test do you do if PE is not likely
Do a d dimer test
• positive then arrange a CTPA
How long should anticoagulation be given for?
3 months
3-6 months in cancer
Management for those with no renal impairment, cancer or antiphospholipid syndrome
1st - Apixaban or Rivaroxaban
If Ci
LMWH (enoxaparin) for 5 days, the edoxaban or dabigatran
Or
LMWH + warfarin for 5 days (or INR is 2.0 on two different occasions
Management for those with renal impairment of 15-50
Apixaban Or Rivaroxaban
Or
LMWH for 5 days, the edoxaban or dabigatran (if crcl 30+)
Or
LMWH or UFH + warfarin for 5 days, then continue warfarin
Management for those with renal impairment of under 15
• UFH
or
• LMWH
Or
• LMWH or UFH + warfarin for 5 days, then continue warfarin
Management for those with renal impairment of those with active cancer
If DOACs not suitable then:
• LMWH
• LMWH + warfarin for 5 days then continue warfarin alone
Management for those with antiphospholipid syndrome
LMWH + warfarin for 5 days then continue warfarin alone
In surgical patients how long is pharmacological prophylaxis sufficient
7 days or until mobilized
Pharmacological prophylaxis for those undergoing elective HIP treatment
(Post)
LMWH for 10 days, then low dose aspirin for 28 days
OR
LMWH for 28 days + anti embolism stocking or riveroxaban
Pharmacological prophylaxis for those undergoing elective KNEE treatment
(Post)
Low dose Aspirin for 14 days
OR
LMWH for 14 days + anti-embolism stocking or Rivaroxaban
Which drug is used for pharmacological prophylaxis for pregnant women are at risk of VTE and are not in active labour, or wbu have given birth, had a misscarge termination with the past 6 weeks
LMWH
When should LMWH be started for those women
4-8 hours after the event
How long should the LMWH be continued for after initiation
7 days
