Drugs to Tx PE/Thromboembolism

Question 1

What are the options for anticoagulant therapy in the Tx of PE? (Rank in order of what to use first)

Which should be used if the patient also has cancer?

Answer 1

1) Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban)
2) Warfarin
3) LMW heparin (enoxaparin)

4) Use LMWH if Pt has cancer

Question 2

What is the duration of anticoagulant therapy?

Answer 2

3 months or longer with first VTE and longer if there is a second unprovoked VTE

Question 3

What can be used for extended treatment of venous thrombosis after 3 months of anticoagulation therapy with no contraindications?

Answer 3

Aspirin

Question 4

Should you use catheter-directed thrombolysis for acute DVT of the leg?

Answer 4

No, anticoagulation is sufficient

Question 5

What is the role of Inferior Vena Cava Filter in addition to anticoagulation for acute DVT or PE?

Answer 5

Don’t use if patient can be treated with anticoagulants

Question 6

What is the role of compression stockings in order to prevent post-thrombotic syndrome?

Answer 6

Not recommended

Question 7

What should be done to treat a subsegmental PE?

Answer 7

Surveillance unless high risk for recurrence, then anticoagulate

Question 8

Can patients be treated for acute PE out of the hospital?

What is the standard release?

Answer 8

1) Yes if home care is adequate

2) 5 days

Question 9

When should systemic thrombolytic therapy be used for PE?

Answer 9

1) If SBP <90 mmHg and they have a low bleeding risk

2) If patient deteriorates after starting anticoagulant therapy

Question 10

Should catheter-based thrombus removal for the initial treatment of PE be used?

Answer 10

While systemic fibrinolytic therapy from peripheral vein is prefered you can do this if circumstances warrant

Question 11

What can be done by an experienced team for the treatment of Chronic Thromboembolic Pulmonary Hypertension?

Answer 11

Pulmonary Thromboendarterectomy

Question 12

In the management of recurrent VTE on anticoagulant therapy what should be used if DOAC or warfarin fail?

Answer 12

LMW heparin

Question 13

In the treatment of PE due to air, what position should you place the patient in to avoid further venous embolization?

Answer 13

1) Left lateral decubitus with head down

OR

2) Trendelenburg

Question 14

What should be administered in the Tx of PE due to air and fat?

Answer 14

1) High flow O2

2) IV fluids