Initial anticoagulation in acute VTE

Question 1

Does LMWH cross the placenta?

Answer 1

No

Question 2

What are the Anti-Xa levels if on UFH?

Answer 2

Peak anti-Xa activity, 3 hours post-injection, of 0.5–1.2 u/ml

Question 3

Collapsed patient with PE

Answer 3

• Women should be managed on an individual basis regarding: intravenous unfractionated heparin,
  thrombolytic therapy or thoracotomy and surgical embolectomy.
• Intravenous unfractionated heparin is the preferred, initial treatment in massive PE with cardiovascular compromise.
• The on-call medical team should be contacted immediately. An urgent portable echocardiogram or
  CTPA within 1 hour of presentation should be arranged. If massive PE is confirmed, or in extreme circumstances prior to confirmation, immediate thrombolysis should be considered.
  -A perimortem caesarean section should be performed by 5 minutes if resuscitation is unsuccessful and the pregnancy is more than 20 weeks.

Question 4

Protocol for unfractionated heparin in collapsed pt

Answer 4

• Loading dose of 80 units/kg, followed by a continuous intravenous infusion of 18 units/kg/hour
• If a patient has received thrombolysis, start infusion at 18 units/kg/hour
• It is mandatory to measure activated partial thromboplastin time (APTT) level 4–6 hours after the
  loading dose, 6 hours after any dose change and then at least daily when in the therapeutic range.
  The therapeutic target APTT ratio is usually 1.5–2.5 times the average laboratory control value.