DVT/PE

Question 1

Risk favtors for DVT/PE

Answer 1

Virchow’s Triad: Endothelial injury, venous stasis, hypercoagulable state

Question 2

Medical DVT prophylaxis:

Answer 2

heparin, enoxaparin (Lovenox), other LMWH (fondaparinux)
For CKD: heparin - others have renal clearance!
For cancer: Lovenox

Question 3

Complications,

Contraindications of anticoag:

Answer 3

Complications: Bleeding, skin necrosis, HIT
Contraindications: bleeding risk, liver disease, severe HTN, surgery/trauma, pregnancy (use warfarin)

Question 4

HIT =

Answer 4

Heparin Induced Thrombocytopenia: 5-10days after heparin, Platelets drop >50%

4Ts: Timing, Thrombocytopenia, Thrombosis, alTernative cause

Question 5

Treatment of HIT:

Answer 5

`1. Stop heparin

2. Direct thrombin inhibitors: argatroban, lepirudin, danapariod (no antidote for these)

Question 6

Protamine is:

Answer 6

Antidote for heparin and LMWH

Question 7

Risk assessment via what scoring system

Answer 7

Well’s Criteria

Geneva score

Question 8

Labs for DVT:

Answer 8

If low risk - DDimer

If med/high risk: ultrasound

Question 9

Labs for PE:

Answer 9

If low risk - DDimer
If med/high risk or positive DDimer: Spiral CT/CTA
If contrast allergy or CKD and med/high risk: V/Q scan

If preg: CXR and or V/Q scan

Question 10

Treatment for DVT short term and long term:

Answer 10

1. Short term: heparin/lovenox. Heparin for CKD, Lovenox for cancer.
2. Long term: Warfarin - start in hospital

Question 11

Monitoring heparin and warfarin:

Answer 11

Heparin: frequent, PTT, platelet count.
Warfarin:: PT/INR, goal INR=2-3

Question 12

Anticoagulation duration fir DVT/PE:

Answer 12

1st, provoked: 3months
1st, unprovoked: 6months
2 or thrombophelia: indefinite
cancer: until cancer gone

Question 13

PE treatment for hemodynamically stable and unstable:

Answer 13

Stable: Anticoag same as DVT, do IVC filter if can’t anticoag.

Unstable: Thrombolysis, surgery if refractory to thrombolysis.

Question 14

Complications of DVT:

Answer 14

1. Post-thrombotic syndrome: venous insufficiency despite anticoag (50% of pts)
2. Compartment Syndrome
3. PE

Question 15

Complications of PE

Answer 15

1. Pulmonary HTN
2. Arrythmias
3. Increase all cause mortality.