Clinical Approach to VTE Flashcards
Factors causing hypercoagulability
Malignancy Pregnancy Surgery Estrogen/OCPs Genetic mutation
Factors causing venous stasis
Bedrest >24 hours
Recent cast or external fixator
Long distance travel
Factors causing venous injury
Recent surgery Recent trauma (especially the lower extremities and pelvis)
What does the ABG look like in PE?
Many patients have normal pulse ox
A-a gradient is usually increased but is non specific
Respiratory alkalosis is most common
3 mechanisms of hypoxemia in PE
Low V/Q
Shunt
Decreased CO
Hamptoms Hump
Radiologic sign of PE
Dome shaped, pleural based opacification in the lung
D-dimer
Fibrin degradation product
Non specific (cancer, sepsis, inflammation)
Negative result excludes PE in PE-unlikley patients
VQ Scan pros and cons
Pros: normal scan excludes PE for low/mod probability, useful if contradindication to IV contrast
Cons: less helpful if parenchyma abnormal, limited availability, frequently indeterminate
4 poor prognostic signs
Hypotension (not caused by arrhythmia, sepsis, or hypovolemia)
Syncope
Shock
Myocardial dysfunction (elevated BNP)
Men and HERDOO2 rule
Men continue and HERDOO2
All men with unprovoked VTE continue anticoags
Women with unprovoked VTE and 2 or more features after 5-12 months of anticoags continue
Features: presence of postthrombotic signs (Hyperpigmentation, Edema, Redness), D-dimer high, Obesity, Older age (65+)
When do you use ASA for VTE?
In patients with an unprovoked proximal DVT/PE who are stopping anticoag therapy and do not have a contraindication to asa
3 indications for thrombolytic therapy
Hypotension
Severe hypoxemia
R heart failure
Surgical thrombectomy
Rarely used
Acute massive PE
Chronic thromboembolic disease complicated by pHTN
