E4. VTE Flashcards
Virchow’s Triad
1) Hypercoagulable State
2) Circulatory Stasis
3) Vascular Injury
Arteries are ____ rich.
Platelet
Veins are ____ rich
Fibrin
How are venous clots treated?
Anticoagulants.
What is the treatment goal of VTE?
To prevent VTE from occurring in patients who are at high risk.
How is VTE treated?
1) Low dose anticoagulation
2) Mechanical prophylaxis.
How do we decide which patients required thromboprophylaxis for VTE?
1) Those with a PADUA score greater than 4, who do not have any contraindications.
PADUA Score:
Active Cancer
3
PADUA Score:
Previous VTE
3
PADUA Score:
Reduced Mobility
3
PADUA Score:
Known Genetic Hypercoagulable condition
3
PADUA Score:
Recent Trauma/Surgery (within 1 month)
2
PADUA Score:
>70 years old
1
PADUA Score:
Cardiac or respiratory failure
1
PADUA Score:
Acute MI or Ischemic Stroke
1
PADUA Score:
Acute Infection or Rheumatologic disorder
1
PADUA Score:
Obesity (>30)
1
PADUA Score:
Hormonal Treatment
1
Non-pharmacologic VTE Treatment
1) Ambulation
2) Graduated Compression Stocking
3) Sequential Compression Devices
4) Inferior Vena Cava Filter
VTE Heparin DOsing
5000 units Q8-12 H
BMI >40 = 7,500 units.
VTE Enoxaparin Dosing
30 units twice daily or 40 units daily.
What cancer patients should be treated with anticoagulant therapy?
Khorana score greater than 2.
What anticoagulants are recommended if khorana score is greater than 2 in active cancer?
1) Apixaban
2) Rivaroxaban
3) LMWH
Patients with multiple myeloma receiving thalidomide or lenalidomide based regimens based regimens with chemotherapy should be offered what anticoagulants?
1) Aspirin or LMWH (low risk)
2) LMWH (high risk)
