2. VTE Flashcards
VTE
VENOUS THROMBOEMBOLISM
what is it ?
Combination of
DVT = deep vein thrombosis
PE = pulmonary embolism
When to medicate VTE pts?
When risk of VTE is higher than the BLEEDING risk
Thrombocytopenia what is it ?
Thrombocytopenia is a condition characterized by abnormally low levels of platelets, also known as thrombocytes, in the blood
Can cause haemorrhage
When to give anticoagulants?
Slow moving Venus clots DVT
apixaban dabigatran edoxaban rivaroxaban warfarin
When to give an antiplatelet
Clot in atrial circulation PE
(Clot made out of platelets)
Clopidogrel
Prasugrel
Ticagrelor
VTE risk factors
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+
Bleeding risk factors
Thrombocytopenia (low platelets) Acute stroke Bleeding disorders Anticoagulant Systolic hypertension (number above)
Mechanical VTE prophylaxis
Stocking
Compression device
If meds are CI what to do?
Offer mechanical prophylaxis
What Tx for renal impairment pts that need stat heparin?
Unfractured (normal) heparin
Dont give LMWH❌
Fondaparinux
Indication
Knee/hip replacement
Prophylaxis of venous thromboembolism in patients after undergoing major orthopaedic surgery of the hip or leg, or abdominal surgery
Edoxaban
Indication
(Mention weight)
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
Treating pts with renal impairment
unfractured heparin/LMWH
How long atleast ? Days
5 days minimum until INR 2
Start oral anticoagulant: warfarin concomitant ✅
How many days
Give heparin in
Major cancer surgery
In abdomen and pelvis
28 days
How many days give heparin in knee/hip surgery
Extended period
What test to do after giving unfractured heparin?
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
Why do we give LMWH In pregnancy?
When to stop?
Lowers risk of what (2)
Doesn’t cross the placenta
Stop at labour onset
Osteoporosis & heparin induced thrombocytopenia a
LMWH
Example
Tinzeparin
enoxaparin
Dalteparin
LMWH
SE
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)
During heparin if bleeding occurs what to do?
Stop stat & seek medical help
LMWH
Antidote
Protamine
Heparin is preferred over LMWH
2
Increased bleeding risk
Renal impairment
Heparin SE
Hyperkalamia
Diabetes
Chronic kidney disease
Osteoporosis
Heparin
When can HIT occur (heparin induced thrombocytopenia)
What to do when platelets decrease by 30%?
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)
