VTE Flashcards
(26 cards)
Statin therapy
Decrease VTE risk
Low risk thromboprophylaxis
Low risk med, same day surgery and
Early aggressive ambulation only
Minor surgery in mobile pt
Mechanical ppx
Hi risk medical
Immobile, history of VTE, thrombophilia or cancer
Most surgical pts
uFH, lmwh, or Fonda if hit positive, or mech. Ppx if high bleeding risk
Ortho surgery
Lmwh or Fonda, rivaroxaban, or warfarin x 35 days plus mech ppx
Phlegmasia cerulea dolens
Stagnant blood leading to edema, cyanosis and pain
Simplified wells score for DVT
2-13
0, 1-2, >=3
D dimer cut off
Less than 500
Simplified wells pretest probability for PE
2-14
0-1, more than 1
RV strain on ECG
RAD, p pulmonale, RBBB, S1Q3T3 and TWI V1-V4
Vq scan
High sensitivity, very low 10% specifity, sp improves with high probability VQ
Discordant CTPE and clinical suspicion
Consider additional imaging studies if high clinical suspicion and no alternative diagnosis
When to consider thrombophilia work up
Positive Fhx, age younger than 50, or on OCP/HRt, send panel 2 was after complete anticoagulation
Risk stratification for pts with PE
Hypotension, tachycardia, hypoxemia
rV to LV dimension >0.9
Elevated trop, BNP assoc with increased mortality
RV dysfunction
PE severity index
0-1, 2 and above
Age more than 80, history of cancer, history HF or lung disease, Hr >= 110, sBp
Catheter associated DVT
Anticoagulant, no need to remove catheter if functional
UFH over LmWH
Renal failure crcl less than 25, extreme obesity, hemodynamically unstable, or bleeding risk
Lmwh and Fonda dose
Enox 1mg/kg bid, dalte 200iu/kg qd
Fonda 5-10mg qd
Riva dose
15 mg bid x 3 weeks, then 20 mg qd
Outpatient treatment
DVT and low risk PE
Indication for thrombolysis in PE
Hemodynamically instability or submassive PE with risk factors with low bleeding risk
Thrombectomy indication for PE
Large prox PE, and hemo compromise, and contra to lysis
Warfarin with heparin overlap duration
More than 5 days, and inr great than 2 for 24 hrs
Dabigatran in PE
Not FDA approved yet
