DVT/PE Lecture Flashcards
what are DVT/SVT in the upper extremities most commonly a complication of?
PICC/Port line placement
what is the VTE rate among high risk populations not receiving thromboprophylaxis?
80 percent
what are some examples of high risk VTE populations?
critical illness, cancer, stroke, pregnancy, heart failure, MI, age over 75, previous VTE, prolonged immobility, renal failure, inherited hypercoagulable state
do we PPX non-high risk populations for VTE with drugs during their hospital stay?
nope
encourage early and often ambulation +/- mechanical PPX
how do we PPX the high risk groups for VTE during their hospital stay?
LMWH or UFH
no need to continue administration beyond acute care stay
what is a warning sign for heparin induced thrombocytopenia? how do we manage?
a 50 percent reduction in platelets = red flag
use 4 T's calculator to assess risk stop ALL heparin type products give arixta (fondapurinax)!
signs and symptoms of a DVT?
lower extremity swelling, pain, discoloration
palpable cord, + homan’s sign (when dorsiflexing foot, feel posterior leg pain), edema
what makes up the well’s criteria for diagnosing probability of DVT? (sadly she asked about it for PE so it may be worth memorizing) – 9 things
- active cancer (TX ongoing or in past 6 month): 1 pt
- paralysis, paresis, recent plaster immobilization: 1 pt
- recently bedridden 3+ days or surgery w/in 4 wks: 1
- localized tenderness along DV system: 1
- entire leg swollen: 1
- calf swelling by 3+cm compared to other: 1
- pitting edema (greater in affected leg): 1
- collateral superficial veins (nonvaricose): 1
- alternative dx less likely than DVT: 2
according to the well’s criteria, at what score makes a DVT likely?
DVT likely 2+
DVT unlikely less than 1
high probability 3+, moderate probability 1 or 2
once our patient is considered high risk according to the well’s criteria, how do we confirm our DX?
ultrasound
how do we manage patients with a DVT? include drugs and how long we treat them for
1) admit
2) start IV heparin or SQ lovenox for 5 days
3) start coumadin right away on day 1
4) observe for complications: PE, phlegmasia cerulea dolens
5) get case management on board ASAP to begin coordinating at home SQ injections
what is our INR goal when treating patient with anticoagulants?
2-3
what is the benefit to using our direct novel oral anticoagulants?
NO heparin overlap needed
can be used as monotherapy!
downside to new direct oral anticoagulants?
short half life (5-9 hours)
avoid if egfr less than 30
dyspnea, tachypnea, pleuritic pain, cough, orthopnea, DVT symptoms, wheezing, and hemoptysis are all signs of what/
submassive PE
to be considered a massive PE, what 2 things are added to the previously mentioned symptoms?
hypotension SBP less than 90 mmHG
RV dilatation and dysfunction (red flag)
how do we confirm DX of PE?
helical CT angiogram
then CT pulmonary angiography
V/Q scan only if CT contraindicated (can’t get this urgently)
to what area of the hospital should massive PEs be sent to? what about submassive PE?
massive = CCU
med/surg floor on telemetry = submassive
what level of care center should a patient with a massive PE be sent to if their PE is amenable to embolectomy?
tertiary
should you get the coagulation studies to assess for conditions like factor 5, protein C and S when patient is inpatient?
NO
obtain AFTER initial TX period is over (3 months) and anticoagulation has been stopped
what is the anticoagulation plan for PE?
same as DVT
5 days heparin or LMWH; bridge to coumadin
if your patient can’t use pharmacologic anticoagulation due to bleeding risk, what is an option for PE ppx?
IVC filter
your high risk patient does not show any signs of lower extremity thrombus, should you proceed with placing a retrievable IVC filter?
YES
thrombus may remain undetected in pelvic or calf veins
clots can also reform quickly post embolization
do all PE and DVT patients need to be admitted?
no, but this is tricky and depends on the institution
you should always get ______ on board ASAP when treating your patient with DVT or PE to help plan discharge
case management
