Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CR3 > VTE Prevention and treatment > Flashcards

VTE Prevention and treatment Flashcards

1
Q

Virchow’s triad

A

Blood Flow
Blood coagulability
Vessel wall damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is VTE?

A

Blood clot starting in veins of calf as DVT
May remain localised
Or may extend proximally and travel through circulation to heart and get pumped to lungs where veins are smaller so gets plugged = PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Consequences of DVT

A 
PE
Post thrombotic syndrome in LT
Leg ulcers at most severe
Future episodes risk
CTEPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hypertension associated with PE

A

CTEPH

Chronic thromboembolic pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Higher risk in who?

A
  • unprovoked episode vs. causative RF or persisting (surgery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Post-thrombotic syndrome

A 
Pain, swelling
Ulceration, skin discolouration
Variable severity
Reduced QoL
40% DVT complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of VTW

A
  • hereditary
  • acquired»»
  • unprovoked&raquo_space;
    (many have hereditary and acquired)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Major RF for VTE

A
  • fracture of hip/pelvis
  • hip knee replacement surgery
  • major trauma
  • major general surgery for malignancy
  • spinal cord injury
  • hospitalisation with acute medical illness
    (anything tthat can happen in hospital or trauma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Minor RF for VTE

A
  • previous
  • malignancy/chemo
  • pregnancy or post partum
  • COCP or hormone therapy
  • central venous line
  • thrombophilia
  • other conditions = IBD, nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Weaker but common RF

A
  • age
  • travel
  • obesity
  • varicose veins
  • diet
  • smoking
  • air pollution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do cancer patients have increased risk

A
  • cancer is prothrombotic
  • immobility
  • surgery and chemo
  • central venous catheters
    (VTE 2nd equal leading cause of death in cancer patients)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RF for VTE in pregnancy

A
  • obesity
  • maternal age >35
  • caesarean section (esp emergency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prevention

A

Thromboprophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NICE VTE Prevention

A
  • all patients on admission assess for VTE and bleeding risk (national risk assessment tool)
  • offer verbal and written info on prevention to patients and carers
  • provide anti-embolism stocking with right size
  • re-assess within 24 hours of admission
  • if at risk offer VTE prophylaxis
  • offer info on discharge
  • offer extended prophylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Methods of thromboprophylaxis

A 
Mechanical = stockings, intermittent pneumatic compression
Pharm = UH, LMWH, fondaparinux, DOACs, aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UH dose

A

5000U
bd or tds
SC

17
Q

LMWH dose

A
  • enoxaparin 40mg sc od
  • dalteparin 5000U sc od
  • tinzaparin 4500 u sc od
18
Q

Fondaparinux dose

A

synthetic pentasaccharide 2.5mg sc od

19
Q

Direct thrombin inhibitor

A

Dabigatran

20
Q

Factor Xa inhibitor

A

Rivaroxaban

Apixaban

21
Q

Mechanism of heparin

A

Requires binding to antithrombin to work
Speeds up inhibition of activated clotting factors
Factors 2a and 10a and thrombin
To inactivate thrombin needs to bind to thrombin sequence and AT

22
Q

LMWH

A

Predominantly inhibit 10a

Most = Not thrombin as not long enough

23
Q

Fonaparinux

A

only pentasaccharide sequence
10a inhibition only
no thrombin inhibition

24
Q

DOACs

A

Etiher Xa if xa in name of drug
Thrombin = dibigitran
Peak level very rapidly, work very quickly
Half life of 12 hours
Metabolised and eliminated through particular systems so interact with other drugs

25
Q

DOAC Renal excretion

A

Dibigatran 80% vs.

Apixiban 25%

26
Q

CI for compression stockings

A
  • peripheral vascular disease
  • leg or buttock pain on exercise
  • previous/planned revasc surgery
  • massive leg oedema so unable to fit
  • interfering dermatitis, recent skin graft, gangrene
27
Q

Alternative to compression stocking

A

Intermittent pneumatic compression
Sleeve around calf which blows up
Mimics walking = increases venous return

28
Q

Treatment

A
  • anticoagulant = prevention extension and recurrence
  • LMWH immediate as works quickly
  • overlap with warfarin until INR in therapeutic range for 2 days (5 days minimum)
  • then stop LMWH
  • continue warfarin for 3months
  • monitor in anticoagulant clinic
29
Q

Strengths of warfarin

A

1mg
3mg
5mg

30
Q

Warfarin

A
  • long half life = 36 hours
  • metabolised in liver
  • Vit K antagonist
  • prevents synthesis of cofactors which use Vit K as coagonist = 2,7,9.10
  • requires regular monitoring of INR
  • risk of major bleeding
31
Q

Pregnancy and warfarin

A

Avoid = teratogenic and bleeding

Safe for breast feeding

32
Q

Alternative treatments

A

5 days LMWH, dabigatran or edoxaban for 3 months
OR
- rivaroxaban or apixaban higher starting dose for 1st week until reach standard dose (no LMWH)

CR3 (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions