Chapter 87 Flashcards
Dose of Alteplase in high risk PE
100 mg delivered through a peripheral vein as a continuous infusion over 2 hours
Benefit even after 14 days after the onset of new symptoms or signs
2 oral drugs approved for VTE
Rivaroxaban 15mg BID x 21days then 20mg OD
Apixaban 10mg BID x 7 days then 5mg BID thereafter
Longterm:
Rivaroxaban 10mg OD
Apixaban 2.5 mgtab BID
European- based randomized controlled trial of 59
patients with intermediate- risk PE, ultrasound- facilitated, catheter-
directed fibrinolysis with 20 mg of t- PA plus anticoagulation reduced
a surrogate endpoint, RV- diameter- to- LV- diameter (RV- to- LV) ratio,
from baseline to 24 hours to a greater extent than anticoagulation
SEATTLE II trial
Level of recommendation for catheter-based therapy as an for VTE
Class II
Role of surgical Embolectomy in VTE
- high- risk PE or intermediate- high- risk PE with severe right ventricular dysfunction and clinical deterioration despite anticoagulation, in
whom contraindications preclude thrombolysis - acute PE who require surgical excision of a right atrial thrombus, closure of a patent foramen ovale, or
excision of a clot- in- transit - rescue therapy for patients whose PE is refractory to thrombolysis
Trial for IVC filter
PREPIC2 trial
IVC filters appear to reduce the short- term risk of subsequent PE, increase the long- term risk for DVT, and have no impact on overall mortality
DVT catheter- directed DVT thrombolysis indication
extensive iliofemoral and upper- extremity venous thrombosis
performed in experienced centers and reserved for highly selected patients with iliofemoral disease, severe symptoms or limb-threatening disease, and a low risk of bleeding.
Trials for DVT catheter-directed DVT thrombolysis
CaVenT study
ATTRACT trial
-Patients treated with catheter- directed thrombolysis had decreased rates of moderate- to- severe PTS, but quality of life did not differ.
Treatment for Superficial thrombophlebitis
Short- term use of fondaparinux (2.5 mg once daily for 45 days) is the
best validated anticoagulation strategy
Trials in Cancer with VTE
HOKUSAI- VTE Cancer trial
SELECT- D
Caravaggio trial
Recommended anticoagulation for cancer patients with Acute DVT
Edoxaban
Rivaroxaban
NCCN gave a top- tier recommendation to
consider edoxaban or rivaroxaban when treating cancer patients with acute VTE and gave a limited recommendation to consider dabigatran or apixaban in situations where LMWH monotherapy was contraindicated or when patients declined LMWH injections
Therapy for secondary prevention for VTE among patients with Antiphospholipid Syndrome
Warfarin
Rivaroxaban versus warfarin in patients with severe
antiphospholipid syndrome, the trial was stopped early because rivaroxaban patients suffered more frequent thromboembolism than warfarin patients (12% vs. zero) and more major bleeding complications
(7% vs. 3%)
APAS is acquired
True of Factor V Leiden, except
A. most frequently diagnosed thrombophilia
B. Acquired
C. higher- than- average risk of suffering a first- time acute PE or DVT.
D. Autosomal dominant
B
True or False about Factor V Leiden:
1. susceptible to
first- trimester miscarriage,
2. DVTs have a low embolization rate
3. rate of recurrent VTE is not higher
ALL true
Treatment of VTE among children
Dabigatran showed a favorable safety profile for treating VTE in children aged ≥3 months to < 18 years
