ESC : Venous Thrombo-embolism

Question 1

Maternal Risk for VTE

Answer 1

VTE 0.05-0.20%

Question 2

Maternal Risk for PE

Answer 2

0.03%

Question 3

Mortality rates VTE

Answer 3

0.5%

Question 4

Mortality rates forPE

Answer 4

1,26: 100 000 uk

Question 5

Reoccurance rate

Answer 5

7.6%

Question 6

Risk factors for VTE classification

Question 7

Risk factors VTE: high-risk factors

Answer 7

unprovoked or oestrogen-related

Question 8

Prevention of VTE

Answer 8

LMWH- enoxaparin 0.5IU/kg/ day

Question 9

S.E of unfractinated heparin

Answer 9

bone loss than ,and the osteoporotic fracture rate is lower 0.04% of pregnant women treated with LMWH.

Question 10

Management of acute venous thrombo-embolism: PE presentation

Answer 10

Dyspnoea 
Chest pain
Tachycardia
Haemoptysis
Collapse

Question 11

Management of acute venous thrombo-embolism: PE diagnosis

Answer 11

A high index of suspicion is important

imaging remains the diagnostic test of choice during pregnancy.

Question 12

Management of acute venous thrombo-embolism: PE D dimer

Answer 12

• D-dimerlevels increase physiologically with each trimester.
• a positive D-dimer tes tin pregnancy is not necessarily indicative
• A negative D-dimer test helps to exclude VTE
• but normal D-dimer concentrations have been reported in pregnant women with VTE,

Question 13

Management of acute venous thrombo-embolism: PE modified Wells score

Answer 13

Question 14

Management of acute venous thrombo-embolism: PE U/S

Answer 14

Compression 7/s ^ sensitivity & specificity for proximal dvt

Question 15

Management of acute venous thrombo-embolism: PE MRI

Answer 15

If u/s inconclusive

Question 16

Management of acute venous thrombo-embolism: PE LMWH

Answer 16

Enoxaparin 1mg/kg bd
Dalteparin 100IU/kg bd
Tinzaparin 175IU/kg aiming for 4-6h Peak anti-Xa of 0.6-1.2 IU/ml

Question 17

Management of acute venous thrombo-embolism: PE UFH

Question 18

Management of acute venous thrombo-embolism: PE thrombolysis

Answer 18

Consider inshock/ severe hypotension

UFH @ 18U/kg/hr, NO loading dose

Question 19

Management of acute venous thrombo-embolism: PE fondaparinux

Answer 19

7.5mg/ d if allergy to LMWH

Question 20

Management of acute venous thrombo-embolism: PE vena cava filter

Answer 20

Limited data in pregnancy

Question 21

Management of acute venous thrombo-embolism: PE postpartum mx

Answer 21

Restart heparin 6hrs post nvd and 12hrs post c/s

Question 22

Acute DVT

Question 23

Management of delivery

Answer 23

therapeutic LMWH, delivery should be planned at @ 39 weeks to avoidthe risk of spontaneous labour while fully anticoagulated,as LMWHcan only bepartially reversed with protamine sulfate.

Answer 24

Question 25

Delivery high risk on therapeutic LMWH

Answer 25

LMWH should be converted to UFH atleast 36h prior to delivery and the infusion stopped some 4–6hours prior to anticipated delivery. A normalized aPTT should guide the use of regional anaesthesia.

Question 26

Delivery in low risk on therapeutic LMWH or ^ dose prophylactic

Answer 26

assuming atypical twice-a-day regimen,the evening LMWH dose should be omitted and induction or caesarean section performed the next morning, with regional anaesthesia started more than 24h after the last doseof LMWH and if no other drugs with impairment of coagulation are used.

Question 27

Management of stage of labour & therapeutic LMWH

Answer 27

Always be actively managed with modified dose oxytocin
2IU oxytocin over 5min to a standard treatment of low dose infusion for 4h[10U of oxytocinin 500mL of normal saline given i.v. at 36mL/h for 4h(12mU/min)

Question 28

Recommendations and treatment of VTE

Answer 28