2. VTE

Question 1

VTE
VENOUS THROMBOEMBOLISM

what is it ?

Answer 1

Combination of

DVT = deep vein thrombosis

PE = pulmonary embolism

Question 2

When to medicate VTE pts?

Answer 2

When risk of VTE is higher than the BLEEDING risk

Question 3

Thrombocytopenia what is it ?

Answer 3

Thrombocytopenia is a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood

Can cause haemorrhage

Question 4

When to give anticoagulants?

Answer 4

Slow moving Venus clots DVT

apixaban 
dabigatran 
edoxaban 
rivaroxaban 
warfarin

Question 5

When to give an antiplatelet

Answer 5

Clot in atrial circulation PE
(Clot made out of platelets)

Clopidogrel
Prasugrel
Ticagrelor

Question 6

VTE risk factors

Answer 6

surgery, trauma,
significant immobility,
malignancy, obesity,
acquired or inherited hypercoagulable states,
pregnancy and the postpartum period,
hormonal therapy (combined hormonal contraception or hormone replacement therapy)
Age 40+

Question 7

Bleeding risk factors

Answer 7

Thrombocytopenia (low platelets) 
Acute stroke
Bleeding disorders 
Anticoagulant 
Systolic hypertension (number above)

Question 8

Mechanical VTE prophylaxis

Answer 8

Stocking

Compression device

Question 9

If meds are CI what to do?

Answer 9

Offer mechanical prophylaxis

Question 10

What Tx for renal impairment pts that need stat heparin?

Answer 10

Unfractured (normal) heparin

Dont give LMWH❌

Question 11

Fondaparinux

Indication

Answer 11

Knee/hip replacement

Prophylaxis of venous thromboembolism in patients after undergoing major orthopaedic surgery of the hip or leg, or abdominal surgery

Question 12

Edoxaban

Indication

(Mention weight)

Answer 12

Treatment of deep-vein thrombosis
Prophylaxis of recurrent deep-vein thrombosis
Treatment of pulmonary embolism
Prophylaxis of recurrent pulmonary embolism

Different dosing for 61kg and under and
61kg and over

Question 13

Treating pts with renal impairment
unfractured heparin/LMWH

How long atleast ? Days

Answer 13

5 days minimum until INR 2

Start oral anticoagulant: warfarin concomitant ✅

Question 14

How many days
Give heparin in

Major cancer surgery
In abdomen and pelvis

Answer 14

28 days

Question 15

How many days give heparin in knee/hip surgery

Answer 15

Extended period

Question 16

What test to do after giving unfractured heparin?

Answer 16

APTT= Activated Partial thromboplastin

The partial thromboplastin time or activated partial thromboplastin time is a blood test that characterizes coagulation of the blood.
How long does it take for your blood to form
A clot

Question 17

Why do we give LMWH In pregnancy?

When to stop?

Lowers risk of what (2)

Answer 17

Doesn’t cross the placenta

Stop at labour onset

Osteoporosis & heparin induced thrombocytopenia a

Question 18

LMWH

Example

Answer 18

Tinzeparin

enoxaparin

Dalteparin

Question 19

LMWH

SE

Answer 19

Uncontrolled bleeding (most serious side effect)

Injection site reactions such as redness, irritation and bruising.

Loss of bone strength (less than UFH)

Elevated liver enzymes.

Heparin induced thrombocytopenia (HIT)

Question 20

During heparin if bleeding occurs what to do?

Answer 20

Stop stat & seek medical help

Question 21

LMWH

Antidote

Answer 21

Protamine

Question 22

Heparin is preferred over LMWH

2

Answer 22

Increased bleeding risk

Renal impairment

Question 23

Heparin SE

Answer 23

Hyperkalamia

Diabetes
Chronic kidney disease
Osteoporosis

Question 24

Heparin
When can HIT occur (heparin induced thrombocytopenia)

What to do when platelets decrease by 30%?

Answer 24

5-10 days after given heparin STOP IMMEDIATELY if it happens

Signed of hit: reduced platelets, skin allergy,thrombosis

Stop
Heparin and change to danaparoid

(Prevention of deep-vein thrombosis in general or orthopaedic surgery)