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CVD - HIGH WEIGHTED > CVD - BLOOD CLOTS > Flashcards

CVD - BLOOD CLOTS Flashcards

1
Q

What is a DVT?

A

Clot that occurs in a deep vein, usually in calf of one leg

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2
Q

What is a PE?

A

Detached blood clot which travels to the lungs and blocks the pulmonary artery

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3
Q

What are some risk factors of VTE?

A

Immobility, Obesity, Malignant disease, History of VT, Thromboembollic disorder, Pts >60, Pregnancy, HRT/COC

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4
Q

What is an example of mechanical prophylaxis?

A

Compression stockings

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5
Q

What are examples of pharmacological prophylaxis?

A

Parenteral anticoagulants - LMWH, UFH, Fondaparinux

NOACS - Rivaroxaban, edoxaban, dabigatran

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6
Q

How long would you need to have VTE prophylaxis for if you were undergoing general surgery?

A

5-7 days or until sufficiently mobile

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7
Q

How long would you need to have VTE prophylaxis for if you were undergoing cancer surgery in the abdomen or pelvis?

A

28 days

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8
Q

How long would you need to have VTE prophylaxis for if you were undergoing knee or hip surgery?

A

Extended duration

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9
Q

How long would you treat a patient with LMWH/UFH and what would you monitor?

A

For at least 5 days and until INR is at 2 or more for at least 24 hours

Monitor APTT if UFH given

Start oral anticoagulant at the same time, usually warfarin

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10
Q

Which heparin would you use in pregnancy and why?

A

LMWH - do not cross placenta - lower risk of osteoporosis and heparin induced thrombocytopaenia

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11
Q

What are the key differences between LMWH and UFH?

A

UFH - short duration of action, need to measure APPT, preferred in renal impairment and where there is high bleeding risk

LMWH (tinzaparin, enoxaparin, dalteparin) - longer duration of action, lower side effect profile, used in pregnancy

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12
Q

What are the side effects of heparins?

A

Haemorrhage - withdraw heparin. antidote = protamine

Hyperkalaemia - higher risk in DM and CKD. Monitor before treatment and if greater than 7 days use

Osteoporosis

Heparin induced thrombocytopaenia - occurs 5-10 days after - 30% platelet reduction, skin allergy, thrombosis

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13
Q

How is enoxaparin dosed?

A

<49kg = 40mg BD

50-69kg = 60mg BD

70-89kg = 80mg BD

> 90kg = 100mg BD

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14
Q

How long does warfarin take before it starts to work?

A

48-72 hours

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15
Q

What are the warfarin colours?

A

0.5 - white

1 - brown

3 - blue

5 - pink

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16
Q

How is warfarin dosed?

A

5mg initially and monitor INR every 1-2 days

maintenance dose = 3-9mg at the same time each day

17
Q

How often should you monitor INR once you are stable on warfarin?

A

Every 3 months once stable

18
Q

What is the duration of warfarin treatment for an isolated calf DVT?

A

6 weeks

19
Q

What is the duration of warfarin treatment for a provoked VTE?

A

3 months

20
Q

What is the duration of warfarin treatment for an unprovoked VTE?

A

3 months - long term

21
Q

What is the normal INR range for healthy people?

A

2-3.5

22
Q

What are warfarin interactions?

A

Vitamin K antagonists

Daktarin and other inhibitors

23
Q

What are side effects of warfarin?

A

Bleeding - if major bleeding stop warfarin and give IV phytomenadione (vitamin e). dried prothrombin complex or fresh frozen plasma - do this if INR is greater than 8 even if bleeding not present

Calciphylaxis

24
Q

What would you do if the INR was high (5-8) but there was no bleeding?

A

Withhold 1-2 doses, reduce maintenance dose, measure INR after 2-3 days

25
Q

How many days before surgery would you stop warfarin?

A

5 days before

26
Q

How is edoxaban dosed?

A

Up to 61kg = 30mg OD

> 61kg = 60mg OD

27
Q

What is the long term management of a TIA (mini stroke)?

A

Aspirin 300mg immediately then clopidogrel 75mg OD OR M/R dipyridamole 200mg BD and aspirin 75mg OD

28
Q

What is the long term management of an ischaemic stroke?

A

Alteplase within 4.5 hours of onset + aspirin + PPI then clopidogrel 75mg OD or dipyridamole + aspirin

29
Q

What is the long term management of both a TIA and Ichaemic stroke?

A

Statin

Treat HTN but not with a BB unless on it already for another indication

30
Q

How do you take dipyridamole?

A

30-60 minutes before food

31
Q

After how many weeks must you discard dipyridamole?

A

6 weeks

CVD - HIGH WEIGHTED (10 decks)

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