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Clin Med I Exam #4 > 3 DVT/PE > Flashcards

3 DVT/PE Flashcards

1
Q

What are the three aspects of Virchow’s Triad?

A
  1. Stasis
  2. Hypercoagulability
  3. Vessel wall injury
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2
Q

What is one of the most significant risk factors of thromboembolisms?

A

PREVIOUS thrombotic event

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3
Q

What are the three most common chronic conditions that are considered risk factors for thromboembolism?

A
  • Malignancy
  • Antiphospholipid antibody syndrome
  • Myeloproliferative disorders
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4
Q

What are the four most common transient states that are considered risk factors for thromboembolism?

A
  • Surgery
  • Trauma
  • Immobilization
  • Presence of central venous catheter
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5
Q

What are the two most common female-specific factors that are considered risk factors for thromboembolism?

A
  • Pregnancy

- Hormonal contraceptives (BCP)

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6
Q

What are the two most important inherited risk factors (i.e. mutations) associated with thromboembolism?

A
  • Factor V Leiden mutation

- Prothrombin gene mutation

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7
Q

What are the two most significant signs/symptoms of a DVT?

A
  • Swelling

- Larger calf diameter

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8
Q

What constitutes as a high probability for DVT per the Wells criteria?

A

3+ points

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9
Q

What constitutes as a moderate probability for DVT per the Wells criteria?

A

1-2 points

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10
Q

What constitutes as a low probability for DVT per the Wells criteria?

A

0/negative points

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11
Q

If a HIGH probability for DVT is obtained per the Wells criteria, what is the next step in the diagnostic plan?

A

Order compression ultrasound

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12
Q

If you’re looking for a DVT with compression ultrasound, what is considered a positive finding?

A

+ for DVT if loss of vein compressibility

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13
Q

If a LOW/MODERATE probability for DVT is obtained per the Wells criteria, what is the next step in the diagnostic plan?

A

Order D-Dimer test

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14
Q

What is considered a positive D-Dimer test?

If the D-Dimer test is POSITIVE, what is the next step in the diagnostic plan? What if the D-Dimer is NEGATIVE?

A

> 500 ng/mL

  • If positive, order US
  • If negative, STOP TESTING
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15
Q

What is the treatment for a proximal DVT? What about for a distal DVT?

A
  • Proximal DVT: ALWAYS anticoagulation therapy

- Distal DVT: consider anticoagulation therapy

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16
Q

What is the goal of anticoagulation therapy?

A

PREVENT further clot propagation/PE or complications

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17
Q

If a DVT occurs in the upper extremity, which two veins are most commonly occluded?

A
  • Axillary v.

- Subclavian v.

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18
Q

What is the most common cause of an upper extremity DVT?

A

Catheter placement

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19
Q

How can you differentiate

Superficial Thrombophlebitis from DVT?

A

Superficial Thrombophlebitis involves dull pain, induration and redness but NO EDEMA

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20
Q

What gender/age is most commonly affected by PEs?

A

Older men

21
Q

What are the four classifications of PE that must be considered?

A
  • Hemodynamic stability
  • Temporal pattern (acute, subacute, chronic)
  • Anatomic location (saddle, lobar, segmental, subsegmental)
  • Symptomatic vs. Asymptomatic
22
Q

What is considered hemodynamically unstable with a PE (think BP changes)?

A

Unstable if systolic BP <90 mmHg or drop in systolic BP of 40+ mmHg from baseline for 15+ minutes

23
Q

What two symptoms are most commonly associated with a PE?

A
  • SOB/dyspnea

- Pleuritic chest pain

24
Q

If a PE is hemodynamically unstable, what is the next step in the diagnostic plan?

A

Echocardiography (other definitive imaging is unsafe)

25
Q

If a PE is hemodynamically stable, what is the next step in the diagnostic plan (4)?

A

Combine clinical with Wells for PE, D-Dimer test, and CTPA

26
Q

If a HIGH probability for PE is obtained per the Wells criteria, what is the next step in the diagnostic plan?

A

Order CTPA

27
Q

If a LOW/MODERATE probability for PE is obtained per the Wells criteria, what is the next step in the diagnostic plan?

A

Apply PERC (list of 8 PE rule out criteria)

28
Q

What is considered a positive PERC test?

If the PERC test is POSITIVE, what is the next step in the diagnostic plan? What if PERC is NEGATIVE?

A

PERC: ALL 8 criteria are negative

  • If positive, order D-Dimer
  • If negative, STOP TESTING
29
Q

If a CTPA cannot be obtained to rule out PE, what is an alternative test that can be considered?

A

Ventilation perfusion scan (V/Q)

30
Q

What is the treatment for a PE?

A

ALWAYS anticoagulation therapy

31
Q

Which three anticoagulation therapy options are preferred to IV unfractionated Heparin to treat thromboembolisms?

A
  • SubQ Factor Xa inhibitor (Fondaparinux)
  • Oral Factor Xa inhibitor
  • SubQ Lovenox
32
Q

What three conditions for thromboembolisms would warrant treatment with IV unfractionated Heparin?

A
  • Severe renal failure
  • Hemodynamically unstable PE
  • Massive iliofemoral DVT
33
Q

For which two population groups is Lovenox (LMWH) considered the DOC to treat thromboembolisms?

A
  • Pregnant

- Active cancer

34
Q

The drugs that end in “aban” are from what type of inhibitor group to treat thromboembolisms? Are these drugs oral or IV?

i.e. Rivaroxaban (Xarelto), Apixaban (Eliquis), Edoxaban, Betrixaban

A

Factor Xa inhibitors

- The “aban” drugs are all oral

35
Q

What is the one IV Factor Xa inhibitor?

A

Fondaparinux

36
Q

What is the one Direct Thrombin inhibitor? Is this drug oral or IV?

A

Dabigatran (Pradaxa)

- Oral

37
Q

What is the most common long-term anticoagulation therapy used to treat thromboembolisms?

A

Warfarin

38
Q

Why might a patient/provider consider use of an oral Factor Xa inhibitors OR oral thrombin inhibitors instead of Warfarin?

A

To avoid the burden of PT/INR monitoring (as with Warfarin)

39
Q

What is the recommended duration of anticoagulation treatment for a first episode thromboembolism?

A

Minimum of 3 months for 1st episode

40
Q

What is the recommended duration of anticoagulation treatment for a provoked thromboembolism? What is an example of a provoked VTE?

A

3 months

- Could occur with surgery

41
Q

What is the recommended duration of anticoagulation treatment for an unprovoked thromboembolism?

A

LONGER (6-12 months)

42
Q

What four conditions would warrant lifelong/indefinite anticoagulation treatment for a thromboembolism?

A
  • 1st episode of unprovoked proximal PE/symptomatic PE
  • Recurrent episodes of unprovoked proximal PE/symptomatic PE
  • Underlying thrombophilia
  • Active malignancy
43
Q

What is the most common anticoagulation reversal therapy we discussed? Why would you want to use reversal therapy?

A

aPCC

- Use if blood too thin OR bleeding out

44
Q

What are three adjunctive treatment options to anticoagulation?

A
  • Thrombolytics
  • IVC filter
  • Thrombectomy/Embolectomy
45
Q

What is another name for Thrombolytics (describes their function)?

A

Clot buster

46
Q

What two adjunctive treatment options to anticoagulation should be considered for a hemodynamically unstable PE patient?

A
  • Thrombolytics

- Thrombectomy/Embolectomy

47
Q

What four minimum criteria must be met in order for a patient to be considered for discharge home (rather than admission) for thromboembolisms?

A
  • Pain controlled
  • Compliant/reliable
  • Capable of administering injections if subQ tx
  • Able to pay for injectable agents while transitioning to oral Warfarin
48
Q

What four VTE prophylactic measures can be used (prevention is key…)?

A
  • Intermittent pneumatic compression (IPCs)
  • Thromboembolic deterrent (TED)
  • Graduated compression stockings (GCS)
  • EARLY ambulation

Clin Med I Exam #4 (7 decks)

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