DVTs

Question 1

Pts. who get secondary prevention of DVT

Answer 1

First or second non-provoked DVT or PVE w/ bleeding risk

Question 2

DVT prevention in Cancer pts.

Answer 2

Use LMW-Heparin until cancer has resolved

Question 3

Upper extremity DVT tx

Answer 3

Use LMWH or Fondaparinux for at least 3 months

-If catheter assoc., leave catheter in place

Question 4

Calf Vein Thrombosis Tx

Answer 4

If sx not severe, monitor every two weeks w/ US

If sx severe, treat

Question 5

Superficial Thrombosis Tx

Answer 5

Receive prophylactic dose of fondaparinux for 45 days

Question 6

DVT Treatment in pregnancy

Answer 6

LMWH preferred because it won’t cross the placenta but discontinue 24hrs prior to delivery

Can use heparin or warfarin after delivery

Question 7

Measure that provides most useful measure for short-term outcomes on admission of possible PE patient

Answer 7

Blood pressure (hypotension is bad)

Question 8

Thrombolytic Therapy Guidelines

Answer 8

Usually not indicated unless pt. is unstable and there are no major CIs; systemic infusion w/ short infusion time is preferred

Definitely don’t do on a severely hypotensive pt.

Question 9

HIT tx

Answer 9

Administer DTI therapy

Do not start Warfarin until platelet >150

Question 10

Clinical Pre-test probability of a DVT

Answer 10

Cancer

Recent immobilization

Vein Tenderness

Limb swelling

Pitting Edema

Cast

Question 11

Duration of tx of VTE

Answer 11

Major/Minor risk factor =» 3 months and future prophylaxis

Cancer-Related =» As long as the cancer is active; use LMWH

Unprovoked thrombosis =» 3 months, possibly indefinitely if no bleeding risk

Thrombophilia =» Indefinite

Question 12

Candidates for Thrombophilia work-up during VTE management

Answer 12

Pts. younger than 50 yrs

Family history of VTE

Recurrent thromboses

Women of childbearing age

Suspicion for antiphospholipid syndroe (low-yield)

Question 13

Clinical Pre-test probability of a DVT

Answer 13

Cancer

Recent immobilization

Vein Tenderness

Limb swelling

Pitting Edema

Cast

Question 14

Duration of tx of VTE

Answer 14

Major/Minor risk factor =» 3 months and future prophylaxis

Cancer-Related =» As long as the cancer is active; use LMWH

Unprovoked thrombosis =» 3 months, possibly indefinitely if no bleeding risk

Thrombophilia =» Indefinite

Question 15

Candidates for Thrombophilia work-up during VTE management

Answer 15

Pts. younger than 50 yrs

Family history of VTE

Recurrent thromboses

Women of childbearing age

Suspicion for antiphospholipid syndroe (low-yield)

Question 16

Clinicl Pre-test probability of DVT

Answer 16

Clinical signs/symptoms= +3

Alternate explanation less likely= +3

HR > 100= +1.5

Immobilization = +1.5

Prior DVT = +1.5

Hemoptysis= 1

Malignancy= 1

> 6=high probability; administer heparin and do ultrasound

Question 17

Acute Proximal DVT tx

Answer 17

Early ambulation, outpt. management preferred

-also give compression stockings

Question 18

IVC Filter Guidelines

Answer 18

Usually not indicated because it may help the current PE but will increase likelihood of future DVT

Use if pt. has contraindication to anticoagulants or has surgery for thromboembolic pulmonary HTN