CV: Venous thromboembolism Flashcards
Patients considered at high risk for VTE are: (6)
- Substantial reduction in mobility
- Obesity
- Malignant disease
- VTE history
- Thromophilic disorder
- Patients over 60.
A low molecular weight heparin is suitable in all types of general and orthopaedic surgery. What is preferred for patients in renal failure?
Heparin (unfractionated)
Fondaparinux sodium is an option for patients undergoing what?
Hip or knee replacement.
Hip fracture surgery
GI, bariatric or day surgery procedures.
The oral anticoagulants: apixaban, dabigatran, rivaroxaban are indicated for thromboprophylaxis following what?
Hip or knee replacement surgery.
Edoxaban is not.
Pharmacological prophylaxis in general surgery should usually continue for 5–7 days, or until sufficient mobility has been re-established. Pharmacological prophylaxis should be extended to how many days after major cancer surgery in the abdomen or pelvis?
28
How does edoxaban work?
It is an inhibitor of factor Xa.
Edoxaban, an inhibitor of factor Xa, is given orally for the treatment and prophylaxis of VTE.
It should not be used as an alternative to what in pulmonary embolism in patients with haemodynamic instability?
it should not be used as an alternative to unfractionated heparin in pulmonary embolism in patients with haemodynamic instability, or who may receive thrombolysis or pulmonary embolectomy.
For the initial treatment of deep-vein thrombosis and pulmonary embolism, what is used?
LMWH; alternatively heparin unfractionated as an intravenous loading dose followed by continuous IV infusion (think renal failure).
In the initial treatment of VTE, an oral anticoagulant (usually warfarin) is started at the same time as unfractionated or LMWH. How long does the heparin need to be continued for?
at least 5 days and until the INR is >2 for at least 24 hours.
Why are heparins used for the management of VTE in pregnancy?
They do not cross the placenta.
In the management of VTE in pregnancy why are LMWH preferred over UFH?
They have a lower risk of osteoporosis and of heparin-induced thrombocytopenia.
Why does alteration of the dosage regimen of LMWH such as dalteparin, enoxaparin and tinzaparin need to occur in pregnancy?
LMWH are more rapidly eliminated in pregnancy.
How can rapid reveral of heparin be achieved?
Protamine sufate but only partially works on LMWH
What monitoring is used for heparin (unfractionated)?
Determination of the activated partial thromboplastin time (APT)
