ESC : Venous Thrombo-embolism Flashcards

1
Q

Maternal Risk for VTE

A

VTE 0.05-0.20%

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2
Q

Maternal Risk for PE

A

0.03%

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3
Q

Mortality rates VTE

A

0.5%

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4
Q

Mortality rates forPE

A

1,26: 100 000 uk

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5
Q

Reoccurance rate

A

7.6%

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6
Q

Risk factors for VTE classification

A
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7
Q

Risk factors VTE: high-risk factors

A

unprovoked or oestrogen-related

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8
Q

Prevention of VTE

A

LMWH- enoxaparin 0.5IU/kg/ day

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9
Q

S.E of unfractinated heparin

A

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

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10
Q

Management of acute venous thrombo-embolism: PE presentation

A
Dyspnoea 
Chest pain
Tachycardia
Haemoptysis
Collapse
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11
Q

Management of acute venous thrombo-embolism: PE diagnosis

A

A high index of suspicion is important

imaging remains the diagnostic test of choice during pregnancy.

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12
Q

Management of acute venous thrombo-embolism: PE D dimer

A
  • 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,
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13
Q

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

A
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14
Q

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

A

Compression 7/s ^ sensitivity & specificity for proximal dvt

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15
Q

Management of acute venous thrombo-embolism: PE MRI

A

If u/s inconclusive

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16
Q

Management of acute venous thrombo-embolism: PE LMWH

A

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

17
Q

Management of acute venous thrombo-embolism: PE UFH

A
18
Q

Management of acute venous thrombo-embolism: PE thrombolysis

A

Consider inshock/ severe hypotension

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

19
Q

Management of acute venous thrombo-embolism: PE fondaparinux

A

7.5mg/ d if allergy to LMWH

20
Q

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

A

Limited data in pregnancy

21
Q

Management of acute venous thrombo-embolism: PE postpartum mx

A

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

22
Q

Acute DVT

A
23
Q

Management of delivery

A

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.

24
Q
A
25
Q

Delivery high risk on therapeutic LMWH

A

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.

26
Q

Delivery in low risk on therapeutic LMWH or ^ dose prophylactic

A

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.

27
Q

Management of stage of labour & therapeutic LMWH

A

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)

28
Q

Recommendations and treatment of VTE

A