DVT/PE

Question 1

How do you reverse warfarin?

Answer 1

Prothrombin X (25 units per Kg)

FFP (one bag)

Vitamin K

Question 2

What are some treatment options for PE?

Answer 2

Therapeutic clexane

Heparin

Alteplase

Question 3

What is the mechanism of action of rivaroxaban?

Answer 3

Inhibitor of factor 10a

Question 4

What are some presenting symptoms of PE?

Answer 4

SOB

Chest pain

Calf pain

Haemoptysis

Cough

Question 5

What are some options for prophylaxis?

Answer 5

Chemical prophylaxis - exonaparin

Mechanical - TEDS, intermittent pneumatic compression

Early mobilisation

IVC filter

Question 6

What is the mechanism of action of clopidogrel?

Answer 6

Blocks the P2Y12 receptor on platelets that ADP binds to

Question 7

What constitutes major surgery?

Answer 7

Abdominal surgery >45minutes

Question 8

What are some risk factors?

Answer 8

Hospialised/not ambulating

Pelvic/laproscopic surgery

Malignancy

Hypercoagulable states

Obesity

Pregnancy

Question 9

What anticoagulation is required for stents?

Answer 9

Bare metal

• Life long aspirin
• 4 months clopridogrel

Drug eluding

• Life long aspirin
• 12 months clopridogrel

Question 10

What is the mechanism of action of heparin?

Answer 10

It activates antithrombin III causing inactivation of thrombin and factor 10a and hence reduced clotting

Question 11

When do you use an IVC filter?

Answer 11

Patient with Hx of DVT/PE where anticoagulation is contraindicated

Question 12

Does chemical prophylaxis increase the risk of bleeding in surgery?

Answer 12

Not for major bleeds

Some haematomas

Question 13

What is co-plavix?

Answer 13

Clopridogrel + aspirin

Question 14

How does warfarin work?

Answer 14

Inhibits vitamin K reductase thereby blocking synthesis of vit K dependent clotting factors - 2,7,9, and 10

Question 15

What is the mechanism of action of apixaban?

Answer 15

Factor 10a inhibitor

Question 16

What is the mechanism of action of dabigitran?

Answer 16

Direct thrombin inhibitor

Question 17

Why is laproscopic surgery higher risk for DVT?

Answer 17

Venous stasis

Question 18

How long do you place someone on prophylaxis?

Answer 18

5-7 days or until fully mobile

Extended prophylaxis for major pelvic surgery/in the setting of malignancy

Question 19

What are some primary disease of hypercoagulation?

Answer 19

Factor V leiden

Anti-phospholipid syndrome

Protein C/S deficiency

Lupus anticoagulant

Question 20

What are the WELLS criteria? What is their purpose?

Answer 20

Symptoms of DVT (3pt)

Symptoms not attributable to another pathology (3pt)

Immobilisation (>3days) or surgery in prev four weeks (1.5pt)

Tachycard >100 (1.5pt)

PHx of DVT or PE (1.5pt)

Presence of haemoptysis (1pt)

Presence of malignancy (1pt)

To determine pretest probability when performing a CTPA - >6 is high risk and a CTPA can be performed without D-dimer