Clotting

Question 1

Which DVTs are proximal?

Answer 1

Popliteal or more proximal veins

Question 2

When do most deaths from DVTs occur?

Answer 2

Prior to disgnosis or management

Question 3

If anticoagulant therapy for distal DVT is contraindicated, what is the Mx?

Answer 3

Ultrasound surveillance over two weeks

Question 4

What percentage of untreated distal DVT will cause proximal DVT?

Answer 4

15%

Question 5

What Ix to order prior to starting anticoagulation for DVT/PE?

Answer 5

Coagulation studies - APTT, INR
FBE, UEC, LFT
Beta-HCG

Question 6

Mx for DVT/PE

Answer 6

1. Factor Xa inhibitors - Apixaban, rivaroxiban
2. Dabigatran with parenteral anticoagulant
3. Warfarin with parenteral anticoagulant
4. Unfractionated heparin

Question 7

Which parenteral therapy is used with dabigatran or warfarin?

Answer 7

Enoxaparin, dalteparin

- Started concurrently with warfarin or 5 days before dabigatran

Question 8

Duration of anticoagulant therapy for DVT/PE

Answer 8

Proximal provoked - 3 months
Distal provoked - 6 weeks
Unprovoked - 3 months

Question 9

Mx for unstable PE

Answer 9

Fibrinolysis - alteplase, tenecteplase followed by enoxaparin
Surgery

Question 10

What is post-thrombotic syndrome?

Answer 10

Chronic dependent swelling and pain, discomfort on walking, and skin discolouration followign DVT

Question 11

How is post-thrombotic syndrome prevented/treated?

Answer 11

Gradated compression stockings

Question 12

VTE Mx during pregnancy/breast-feeding?

Answer 12

Enoxaparin

Question 13

VTE Mx for cancer VTE?

Answer 13

Enoxaparin