DVT in Pregnancy

Question 0

Holmans sign? Use in practice?

Answer 0

Test for DVT in calves – Dorsiflexion of the foot to elicit tenderness

May itself cause embolization of clots. Do not use

Question 1

Risk of DVT pregnancy versus non-pregnancy? Mechanism for DVT in pregnancy?

Answer 1

Five-fold increase.

Increased levels of clotting factors (fibrinogen) and venous stasis (Uterus presses on vena cava)

Question 2

Duplex ultrasound flow study?

Answer 2

Real-time sonography and Doppler flow to assess for DVT

Question 3

Management of DVTs in pregnancy?

Answer 3

Anticoagulation, bed rest, extremity elevation

Question 4

Type of anticoagulation to use in pregnancy?

Answer 4

Heparin (Does not cross placenta well) preferable over Coumadin (Coumadin linked to congenital abnormalities and more difficult to reverse)

Question 5

Mechanism of action of heparin?

Answer 5

Thrombin inhibitor blocks conversion if fibrinogen to fibrin – stabilizes clock and inhibits propagation

Question 6

Heparin regimen?

Answer 6

1. 5-7 days for IV therapy
2. Then Subcutaneous heparin to maintain PTT between 1.5-2.5 for three months
3. Then Prophylactic heparinization for remainder of pregnancy and six weeks postpartum

Question 7

Normal lower limit of platelet count? In pregnancy?

Answer 7

150,000 versus 120,000

Question 8

Consequences of long-term heparin use?

Answer 8

1. Osteoporosis (the inhibition of vitamin K)

2. Thrombocytopenia

Question 9

Mission with history of DVT – use what types of contraception? Complications?

Answer 9

Avoid estrogen – use progestin-only methods of contraception

Irregular uterine bleeding