3 Anticoagulation - Consultant Flashcards
Symoptoms of DVT
Pain
Leg swelling
Redness
if patient has eGFR
UFH
High risk surgeries include
Orthopadedic, hip and knee replacement, gynacological
After surgery continue thromboprophylaxis until
mobile or discharge
commonest way to diagnose a DVT?
colour duplex scan
how to diagnose PE?
Perfusion scan (cannot see on xray)
Wells score tells us (DVT)
Which patients to scan and not
Likelyhood that pt is having a DVT
>2 is high
1-2 moderate
Wells score catagories (DVT):
LEARN
\+1 for: Active cancer Paralysis/ recent plaster Bedridden/surgery Tenderness along deep veins system Entire leg swollen Calf swelling
D dimer levels indicate
….clotting is occurring
D-dimer (or D dimer) is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis
What does the D-dimer test tell us?
Negative - rules out DVT
High - further testing required
Which first: D-dimer or wells score?
Well’s score
When to use D-dimer test?
When the risk is low to EXCLUDE DVT
Well’s score (PE) catagories:
LEARN
\+3: Symptoms of PE Alternative diagnosis less likely \+1.5: Heart rate >100 Immobilisation in past 4 weeks Previous PE/DVT \+1: Haemoptysis Cancer
High >6 ** Moderate 2-6 ** Low
Learn coagulation cascade slide
.
two types of heparin
Large UFH
and
LMWH
Route of admin of
UFH
LMWH
UFH - IV/SC
LMWH - SC only
Which heparins require monitoring
UFH - yes - vital
LMWH - no usually
Cost of heparins
UFH - low
LMWH - high
Which heparin has greater
anti-Xa action
antithrombin action
LMWH - antiXa
UFH - antithrombin
What do you monitor in UFH?
- APTT
- Heprain (antifactorXa) assay is used in specialsed cercumstances (preg,paeds,renal fail)
How often to meaure APTT
every 4h to start then every 6.
Why do we try to avoid UFH?
monitoring is intensive
Why are clotting tests different for UFH and LMWH?
UFH is a bigger molecule which wraps around trapping thrombin
