Cardiac - Blood Clots Flashcards
what factors are considered when doing a VTE risk assessment?
- immobility
- obestity BMI>30
- maligannt idsease
- 60yrs +
- Hx of VTE
what factors contribute to increased risk of bleeding?
- thrombocytopenia (low plt)
- acute stroke
- bleeding disorders (liver failure, Haemophillia, Von Willebrands)
- anticoagulants
- systolic HTN
whats the durations of vte prophylaxis in general surgery?
5 - 7 days
whats the duration of vte prophylaxis in major cancer surgery in abdomen or pelvis?
28 days
in pregnancy what is the preferred vte prophylaxis and why and when is it stopped?
heparins (LWMH)
- lower risk of osteoporosis and heparin-induced thrombocytopenia
- stopped at labour onset
when is unfractioned heparin (standard heparin) preferred over LMWH?
- has a shorter duration of action
- preferred if high risk of bleeding or renal impairment
- need to measure activated partial thromboplastin time (APTT)
whats the antidote for heparin?
protamine
what are the 4 side effects of heparins you need to monitor for?
- haemorrhage - withdraw
- high potassium - inhibt aldersterone secreion, risk is higher in diabetes and CKD
- osteoporosis
- heparin induced thrombocytopenia
what are the clinical signs of HIT?
how should you monitor?
clinical signs = 30% reduction in platelets, skin allergy, thrombosis
monitoring = before treatment and if >4 days use
how long does it take for warfarin to work?
3 days - so need to remember INR represents what was going on 3 days ago
how often is INR monitoried when initated and how much when stable?
initially 1 -2 days
then every 3 months
how long is the treatment with warfarin for isolated calf DVT?
6 weeks
how long is the treatment for provoked vte (COCs, leg plaster cast, pregnancy)
3 months
whats the target INR for VTE, AF, MI, cardioversion, bioprosthetic mitral valve?
2.5
whats the target INR in recurrent VTE?
3.5
