Weber Anticoagulant

Question 1

Describe the pathophysiology of VTE including the role of the coagulation cascade

Answer 1

venous thrombi formed in areas of slow/disturbed blood flow (stasis blood promotes thrombus which decr clotting factor clearance); coagulation cascade: initiation, amplification, propogation (cascade leads to the formation of a “scab”)

Question 2

List the contributing factors to the development of VTE

Answer 2

Virchow’s Triad:
1. hypercoaguable state (malignancy, coagulation factor abnormalities, antiphospholipid antibodies, certain drugs),
2. circulatory stasis (immobility and obesity)
3. endothelial/vascular injury (surgery, trauma, venous catheters)

Question 3

Explain postthrombotic syndrome and the consequences of this condition

Answer 3

complication of DVT (caused by damage to venous valves); leg swelling, skin ulcers, pigmentation, skin hardening

Question 4

List risk factors for development of VTE

Answer 4

age >40, FH, HF, MI, immobilization >10days, obesity, orthopedic injury, prior DVT, pregnancy, contraceptive/estrogen use, paralysis, malignancy, post operative state (w/in 3 mos)

Question 5

List the goals of therapy for VTE

Answer 5

Goals of Treatment: The initial goal is to prevent VTE in at risk
populations. Treatment of VTE is aimed at preventing thrombus extension and embolization, reducing recurrence risk, and preventing longterm complications (eg, postthrombotic syndrome, chronic thromboembolic pulmonary hypertension).

Question 6

List the non-pharmacological treatments used for VTE

Answer 6

Baseline monitoring, compression stockings;
* DVT: bed rest, elevate feet, pain management
* PE: oxygen, mechanical ventilation

Question 7

Recognize the general guidelines for duration of therapy including orthopedic procedures/surgeries

Answer 7

• General surgery: UFH, LMWH, Factor Xa inhibitor recommended, cont prophylaxis up to 28 days after hospital discharge
• Orthopedic procedure: Dabigatran (hip), rivaroxaban, apixaban, UFH, LMWH, fondaparinux, vit K antagonist cont for at least 10-14 days postop, consider up to 35 days

Question 8

Describe the pathophysiology for HIT

Answer 8

immune-mediated, occurs between 7-14 days of starting heparin

Question 9

Identify key components of the clinical presentation for HIT

Answer 9

platelets drop >50% from baseline OR platelet count is <100,000/mm^3

Question 10

Recognize the methods used for diagnosis for HIT

Answer 10

platelet count

Question 11

List the goals of therapy for HIT

Answer 11

prevent VTE and death

Question 12

(Not listed as LO but prob important) HIT management

Answer 12

stop heparin products, give alternate anticoagulant, do not give platelet infusions, do not give warfarin until platelet count >150,000, evaluate for thrombosis