Gyn VTE

Question 1

When is a thrombophilia evaluation warranted?

Answer 1

1. Strong Fm Hx (VTE < 45)
2. Recurrent thrombosis
3. Thrombosis in unusual vascular beds (portal 4. veins, hepatic veins, cerebral veins)
4. Warfarin induced skin necrosis (Protein C Def)
5. Arterial thrombosis (APLS)

Question 2

Caprini Score

Answer 2

1-2 = low risk
3-4 = intermediate risk
>/= 5 = high risk

Balance the risk of bleeding with risk of VTE

Mechanical and/or pharmacologic ppx

Prevention is always preferable to treatment :)

Question 3

Lower extremity signs of DVT

Answer 3

Warm
Swollen (> 3 cm difference in calf circumference)
Locally Tender
Venous Cords

Question 4

Wells Score for clinical suspicion of DVT

Answer 4

0 = low (D-dimer)
1-2 = moderate (D-dimer or US)
>/= 3 = high (get US)

Get 1 point for: Recently bedridden for > 3 days or major surgery within 4 weeks

Automatically puts our patient in “moderate” category

D-dimer not reliable after surgery (or in preg) so go straight to compression US

Question 5

Modified Wells Criteria for PE

Answer 5

< 2 = low risk (D-dimer)
2-6 = Mod Risk (D-dimer, then CT angio if > 500)
> 6 - high risk (CT angio)

Get 1.5 point for immobilization, surgery in the past 4 weeks

D-dimer not reliable after surgery, automatically puts us into getting CT PE

Question 6

First line treatment of PE in hemodynamically stable pt, with CrCl > 30?

Answer 6

DOAC (oral factor Xa inhibitor)

Apixaban
Rivaroxaban

*No monitoring is required :)

Question 7

When is IV UF Heparin consider first line for treatment of PE?

Answer 7

Hemodynamically unstable
CrCl < 30
Obesity > 150 kg
High risk of bleeding

Question 8

Dose of IV UF Heparin to treat PE?

Answer 8

5,000 units IV bolus then 1,200 units/hr

Check aPTT every 6 hours (1.5-2.5 nl)

Check Plt count Day2-3 to assess for HIT

Question 9

When checking an aPTT every 6 hours while on therapeutic IV Heparin, what is the goal aPTT?

Answer 9

1.5 - 2.5 normal

Question 10

If someone develops HIT, what anticoagulant should you switch them to?

Answer 10

Argatroban (direct thrombin inhibitor)