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Block 2.3
Day 2: Dr. Riccio VTE
| Question | Answer |
|---|---|
| Where do fibrin rich clots occur? | Generally in the venous where there is less rapid blood flow Platelets < Fibrin |
| Where do platelet rich clots occur? | Generally in the arterial system where there is rapid flow of blood. Platelets > Fibrin |
| What is DVT? | Deep Vein Thrombosis Occur in the deep veins of the upper or lower extremities, unilateral pain, erythema, and edema. Possible gangrene or amputation. Can embolize and move into a pulmonary system. |
| What is PE? | Pulmonary Embolism Embolus from DVT lodging into pulmonary artery, sudden onset dyspnea and chest pain, possible death. |
| What is Virchow's Triad? | Consists of three categories: coagulopathy, vascular injury, and impaired blood flow. |
| What are the primary and secondary ways coagulopathy occurs? | primary: genetic disorders secondary: cancer, pregnancy, and medications |
| What causes vascular injury? | trauma and surgery |
| What causes impaired blood flow? | venous stasis and turbulent blood flow |
| What VTE risk factors are associated with Coagulopathy? | Factor V Leiden, Protein C & S deficiency, AT deficiency, and antiphospholipid syndrome, metastatic cancer, exogenous estrogen and smoking |
| What VTE risk factors are associated with Vascular injury? | surgery, trauma, and defective fibrinolytic system |
| What VTE risk factors are associated with impaired blood flow? | venous stasis, venous valve damage, vessel obstruction, high blood viscosity |
| T/F Medically-ill patients have a high risk of VTE if greater than ≥4 Padua prediction model score | T, use for everything other than surgery |
| T/F If pt has a ≥4 Padua prediction model score, start prophylaxis | T |
| T/F if pt has <4 Padua prediction model score, no prophylaxis is needed | T |
| T/F when treating pts for VTE prophylaxis, parenteral drugs are used | T |
| T/F if a non-orthopedic surgical pt has a ≥3 Caprini prediction model score, they have high risk of VTE | T |
| T/F if Caprini prediction model score is 0-2 points, use mechanical prophylaxis | T |
| T/F if Caprini prediction model score is ≥3 , prophylaxis is necessary, similar to padua | T |
| Who has the highest risk for VTE in ORTHOpedic surgery? | Total hip arthroplasty (THA), total knee arthroplasty (TKA), or hip fracture surgery (HFS). |
| What is the minimum duration of VTE prophylaxis for orthopedic surgery pts? | 10-14 days prophylaxis pharmacotherapy |
| What is the extended duration of VTE prophylaxis for orthopedic surgery pts? | up to 35 days |
| For VTE prophylaxis of orthopedic surgery, what is the first line therapy? | Lovenox 30mg SC BID |
| For VTE prophylaxis of orthopedic surgery, what is the second line therapy? | UFH 5000 units SC BID or TID dosing Eliquis 2.5 mg PO BID Xarelto 10 mg daily Arixtra 2.5 mg daily Pradaxa (in guideline, not FDA approved) |
| For VTE prophylaxis of orthopedic surgery, what is the third line therapy? | Warfarin daily, aspirin 160-650 mg daily |
| What are C/I for VTE prophylaxis? | active bleeding, bleeding disorder (hemophilia), severe liver disease, and severe thrombocytopenia |
| What are examples of mechanical prophylaxis for VTE prophylaxis? | graduated compression stocking when worn out of bed, intermittent pneumatic compression (IPC) which is worn in bed; at least 18 hours per day |
| What are signs of DVT? | dilated vein (palpable cord) and Homan's sign (extreme pain with dorsiflexion of extremity) |
| What are some laboratory/diagnostic imaging for DVT? | D-dimer, doppler ultrasound (compression US), and venography (gold standard; contrast dye) |
| What are some complications of DVT? | post-thrombotic syndrome, recurrent VTE, and limb amputation |
| What are signs of PE? | tachpnea, tachycardia, diaphoretic/cyanotic |
| What are symptoms of PE? | cough/SOB/hemopytsis. chest tightness/chestpain/palpitation. dizziness/ light-headed |
| What are some laboratory/diagnostic imaging for PE? | D-dimer, spiral CT scan, V/Q scan, and pulmonary angiography |
| What are some complications of PE? | pulmonary infarction, chronic thromboembolic pulmonary hypertension (CTPH), and sudden death |
| What is the duration of VTE pharmacotherapy treatment? | First event: transient cause, provoked VTE: 3 months, Permanent cause, provoked OR unprovoked: extended duration Second Event: extended duration Cancer associate thrombosis; direct anti-factor Xa preferred |
| T/F If drug therapy of DVT doesn't work, use inferior vena cava (IVC) filter. | T |
| T/F It is extremely rare for fibrinolytics to be utilized in VTE treatment. | T |
| What fibrinolytic can be used for DVT? | Catheter directed alteplase |
| What fibrinolytic can be used for PE? | Alteplase 100 mg infued over 2 h through peripheral vein |
| What is the starting dose of Warfarin? | 5 mg orally once daily |
| What is the loading dose of Warfarin? | 5-10 mg orally once daily for first 1-2 days |
| What is the starting dose of Warfarin for special populations? | 2.5mg orally once daily |
| T/F For VTE, bridge warfarin with a parenteral agent for a minimum of 5 days and stable therapeutic INR | T |
| T/F When making adjustments to dosing of Warfarin, it will take 8-15 days for full effect. | T |
| T/F Only use 5mg tablets of warfarin, adjust from there. | T |
| T/F Should never adjust pt's warfarin dose more than 20%. | T |
| What test is used to evaluate someone who may have HIT? | 4T score |
| What tests can be used to confirm lab results of someone who has HIT? | ELISA or SRA |
Created by:
SPangKee
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