DVT/PE Flashcards
A patient in critical care, with cancer, stroke, preg, HF, MI, previous VTE, prolonged immobility, renal failure, or hypercoag state is in what category for a VTE?
High risk
How do you prevent a VTE in a low risk patient?
Pharm, early ambulation, and SCD’s
How do we prevent VTE in the hospital setting for a high risk patient?
Pharm (LMWH or UFH)
Does a patient need to continue LMWH or UFH at home? Nursing facility?
NO need to continue at home
If absolutely necessary, you can continue if they go to SNF
When we prescribe heparin, what should we always look out for?
Heparin induced thrombocytopenia
Use the 4 T’s calculator to evaluate risk
(50% reduction in PLT) → stop all heparin!!!
If a patient on heparin and their platelets drop by 50%, what should we do?
Stop ALL HEPARIN PRODUCTS!!! Including heparin-locks
Use Arixtra
What are some exam findings we would see with a VTE?
Palpable cord, +Homan’s sign, edema, and discoloration
If a patient has a low Well’s criteria – what should we do?
Get an ultrasound and a D-Dimer
How do we treat a DVT in the hospital (classically)?
Admit → confirm with US → anticoag (Heparin + warfarin on day one!!!!) → have a case manager to help with home SQ injections
How long do we continue the heparin or lovenox?
MINIMUM 5 DAYS
What are some of the new changes to DVT treatment?
Direct oral agents (Rivaroxaban and Apixaban ONLY)
*No HEPARIN OVERLAP
Must be taken several times a day (can’t skip doses!) no eGFR less than 30
If a patient presents with dyspnea, pleuritic chest pain, cough, orthopnea, wheezing, and hemoptysis – what type of PE is this?
Submassive