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PR3154 > IC4 - Acute and chronic thromboembolism > Flashcards

IC4 - Acute and chronic thromboembolism Flashcards

1
Q

What are the three components in the Virchow’s Triad?

A

1.Hypercoaguation
2.Vascular damage
3.Circulatory Stasis

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2
Q

Discuss the development of VTE disorder, ACS, AIS.

A

When thrombi is formed (usually above knee sources), the thrombi can move in the blood circulation and deposit in the vein, blocking blood flow and impair gaseous exchange to organs.

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3
Q

What are the symptoms of DVT?

A
  1. Leg swelling, pain, warmth which are usually unilateral
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4
Q

Signs of DVT includes _______ superficial veins (palpable cord) and _____ in back of knee when foot is dorsiflex (Homan’s sign).

A

dilated, pain

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5
Q

What are symptoms of pulmonary embolism?

A

Respiratory symptoms like cough, SOB, chest tightness, palpitation. Dizziness or light headedness

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6
Q

What are the signs of PE?

A

Tachypnea, tachycardia, diaphoretic. In massive PE, hypotension, hypoxic, cyanotic

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7
Q

How is suspected DVT diagnosed?

A

Use of Wells-DVT

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8
Q

What are the two 2 possible DVT?

A
  1. Distal (below knee)
  2. Proximal (above knee)
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9
Q

Distal DVT requires initiation of ______ or ______.

A

anticoagulant, surveillance

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10
Q

What is the plan for diagnosed proximal DVT ?

A

Anticoagulant

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11
Q

For patients with wells-DVT score less than 2, what is the next step that the HCP should undertake?

A

Test for D-dimer

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12
Q

What is released when fibrin mesh is degraded?

A

D-dimer

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13
Q

D-dimer have good _____ predictive value.

A

Negative

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14
Q

When D-dimer value is positive, it is _______ that patient has DVT.

A

not confirmed

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15
Q

How is PE diagnosed?

A

Wells criteria

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16
Q

Patient with a score of less than or equal to 4 for PE well score should be examined for ______.

A

D -dimer

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17
Q

When should thrombolytic therapy followed by anticoagulation with UFH or LMWH be started?

A
  1. PE with severe cardiopulmonary compromise
  2. DVT with high risk of limb loss
18
Q

For patients hospitalised for VTE treatment, when is UFH/low dose LMWH and warfarin treatment (INR>2) given?

A

CrCl < 30ml/min

19
Q

How is decision to continue anticoagulant for VTE made?

A

Look at risk factors and determine if it is transient, provoked or chronic.

20
Q

What are factors favoring use of warfarin?

A
  1. May be used in renal impaired
  2. Reliable measurement assay
  3. Effects of drug interaction can be monitored
21
Q

What are factors favoring DOACs?

A
  1. Fixed dosing no need titrate
  2. Lesser DDI than warfarin
  3. Only dabigatran has initial parental agent
22
Q

What are the two viable options for VTE if patient has CrCl of less than 30ml/min?

A
  1. Warfarin overlapping with UFH
  2. Warfarin overlapping with dose reduced enoxaparin
23
Q

How long is the treatment of VTE with oral anticoagulant?

A

90 days

24
Q

Why do low MW heparin have lesser inhibitory activity against thrombin?

A

Formation of a ternary heparin antithrombin-thrombin complex requires at 18 saccharine units whcih LMWH does not have

25
Q

What factors does -xaban targets?

A

Xa (10a)

26
Q

What factor does -gatran target?

A

IIa

27
Q

What is the factors that warfarin target?

A

2,7,9,10

28
Q

Which DOACs require parental anticoagulants?

A

Dabigatran (IV>=5d then 150mg BD)
Edoxaban (IV>=5d then 60mg/d)

29
Q

Edoxaban is not recommended in patients with CrCl > _____ml/min.

A

95

30
Q

How is rivaroxaban dosed?

A

15mgBD for 3 weeks followed by 20mg/day for 3 to 6 months then 10mg OM

31
Q

How is apixaban dosed?

A

10mg BD x 7 days followed by 5mg BD 6 months then 2.5mg BD

32
Q

What is the thrombolytic used in VTE?

A

Alteplase

33
Q

How can PE be treated in low to intermediate risk patients?

A
  1. Drug of choice if need: LMWH or fondaparinux
  2. If require VKA, overlap with LMHW till INR is 2.5
34
Q

Which group of VTE patients should not be given DOACs?

A
  1. Severe renal impairment
  2. Pregnant and lactation
  3. Antiphospholipid antibody syndrome
35
Q

How are high risk patients treated for PE?

A
  1. Anticoagulant + UFH
  2. Systemic thrombolytic therapy
36
Q

Rescue thrombolytic treatment is recommended if patient is ________ on AC treatment.

A

deteriorating hemodynamically

37
Q

Common thrombolytics used for reperfusion in PE is ____.

A

rtPA

38
Q

Patients with antiphospholipid antibody syndrome should be given _______ oral anticoagulant VKA.

A

indefinite

39
Q

What is the drug of choice for treating VTE in pregnant women?

A

LMWH (1.0mg/kg BD SQ)

40
Q

Enoxaparin dose is reduced in ______ patients.

A

severely renal impaired (<30mL/mins)

41
Q

VTE prophylaxes is given after ___ months.

A

3 to 6

PR3154 (16 decks)

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