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CDM 2 Exam 1 > Lecture 6 - VTE 2 > Flashcards

Lecture 6 - VTE 2 Flashcards

1
Q

High Risk for VTE score

A

> 4 points

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2
Q

Low risk for VTE score

A

0 - 3 points

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3
Q

Hospitalized, acutely ill pt, risk > 4, increased risk of thrombus then….

A

LMWH, LDUH, or Fondaparinux

if critically ill then use LMWH or LDUH

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4
Q

Hospitalized, acutely ill pt, risk > 4, with bleeding or at high risk for major bleeding then….

A

GCS or IPC (nonpharm)

switch to pharm treatment if bleeding risk decreases

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5
Q

Hospitalized, acutely ill pt, risk <3, low risk of thrombus then….

A

no med, can do nonpharm if want but don’t really need

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6
Q

Caveat to Hospizatilized, acutely ill pt….

A

no extension of anticoagulants after discharge

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7
Q

Go to for patients with solid tumors?

A

LMWH

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8
Q

treatment for chronically immobilized patients?

A

don’t have to do prophylaxis due to body adjusting

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9
Q

treatment for ppl traveling long distances and increased risk of VTE

A

moving, calf muscle exercises, use compression stockings (15-30mmHg @ Ankle)

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10
Q

Total Hip or total Knee Arthroplasty Treatment

A

10-14 days of LMWH (preferred), Fonda, apixaban, dabigatran, rivaroxaban, LDUH, warfarin, ASA or IPC

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11
Q

Hip Fracture Surgery Treatment

A

10-14 days of LMWH (preferred), Fonda, LDUH, warfarin, ASA or IPC

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12
Q

Major orthopedic surgery treatment

A
  1. extend therapy in outpatient period up to 35 days
  2. can add IPC
  3. use apixaban or dabigatran if don’t like injection, or rivaroxaban or warfarin
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13
Q

Lovenox (Enoxaparin) LMWH dosing most patients…

A

40 mg SQ daily

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14
Q

Lovenox (Enoxaparin) LMWH dosing for THA/HFS

A

40 mg SQ daily or 30 mg SQ q12h

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15
Q

Lovenox (Enoxaparin) LMWH dosing for TKA

A

30 mg SQ q12h

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16
Q

Lovenox (Enoxaparin) LMWH dosing CrCl < 30ml/min

A

30 mg SQ daily

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17
Q

Lovenox (Enoxaparin) LMWH dosing obesity/ BMI >40

A

increase dose by 30%

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18
Q

injection of Lovenox instructions

A
  1. Wash & Dry hands
  2. Sit or Lie comfortably so that you can see abdomen
  3. Choose area left or right side, 2in from Belly button (love handles)
  4. clean injection site
  5. pinch 1 inch of skin, inject, dispense syringe

** don’t expel air and rotate sites **

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19
Q

UFH dose in typical hospital?

A

5000 units SQ 8-12hr, won’t need renal adjustment

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20
Q

fondaparinux (Arixtra) dosing

A

2.5mg SQ daily for most ppl

Contraindicated <50 kg pts, CrCl 30-50ml/min

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21
Q

Dabigatran for prophylaxis dosing

A

110 mg PO 1-4hr after surgery and hemostasis, or 220 mg if not on day of surgery and after hemostasis

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22
Q

Counseling for Dabigatran

A

dyspepsia
don’t chew/crush
keep in same packaging

23
Q

Dabigatran indications

A

THA

off-label for TKA

24
Q

Rivaroxaban (Xarelto) for prophylaxis indications

A

THA, TKA, acutely ill patients

25
Q

Rivaroxaban (Xarelto) for prophylaxis dosing (TKA + THA)

A

10 mg qd for 10-14 days (TKA) up to 35 days (THA)

26
Q

Rivaroxaban counseling

A

Doses < 15mg can be taken without regard to meals, >15mg = need food

can crush/mix in applesauce or water

27
Q

Rivoroxaban DI

A

avoid using with strong dual p-gp & CYP3A4 inhbitors/inducers

28
Q

Eliquis for prophylaxis indications

A

THA or TKA

29
Q

Eliquis for prophylaxis dosing

A

2.5mg BID starting 12-24 days post-op, for 10-14 days (TKA) up to 35 days (THA)

favored due to being safe

30
Q

UFH for VTE Treatment dosing

A

80 unit/kg IV bolus (10K unit max)

18unit/kg/hr continuous, adjusted as needed using aPTT

31
Q

UFH for VTE is preferred in….

A

pts who are hemodynamically unstable, need thrombectomy, renal failure, obesity?

32
Q

Enoxaparin (Lovenox) VTE treatment dosing

A

1mg/kg SQ q12hr (preferred)

1.5 mg/kg SQ daily

If CrCL < 30, use 1mg/kg SQ daily

** Round to nearest 10mg **

33
Q

Fondaparinux for VTE treatment dosing

A

< 50kg = 5 mg SQ daily
50-100 kg = 7.5 mg SQ daily
> 100 kg = 10 mg SQ daily

34
Q

Fondaparinux for VTE renal impairment adjustment

A

CrCl 30-50 = use caution

CrCl < 30 = contraindicated

35
Q

How to decide which oral option to use?

A
  1. Efficacy
  2. Safety
  3. Feasibility
  4. Cost
36
Q

Warfarin Bridging

A
  1. Start therapeutic dose UFH, LMWH, or fondaparinux w/ Warfarin
  2. Bridge for atleast 5 day, INR > 2 for >24hrs
  3. Discontinue short-acting anticoagulants and dose adjust warfarin as needed
37
Q

Dabigatran & Edoxaban switching

A
  1. Start with therapeutic dose UFH, LMWH or fondaparinux for 5 days
  2. Switch to dabigatran or edoxaban after that
38
Q

Oral options without Bridge/Overlap

A

Rivaroxaban and Apixaban

39
Q

Rivaroxaban Dosing VTE treatment

A

15 mg po BID X 21 days with meals, then 20 mg po daily with meals

avoid using in CrCl < 30ml/min

40
Q

Apixaban Dosing VTE treatment

A

10 mg PO BID 7 days, then 5 mg PO BID

no adjustment necessary in renal impairment

reduce dose 50% if given with dual CYP3A4/p-gp inhibitor

41
Q

Dabigatran Dosing VTE treatment

A

5 days of parenteral AC, then 150mg PO BID

42
Q

Edoxaban Dosing VTE treatment

A

5 days of parenteral AC, then weight based….

>60kg = 60mg daily
<60kg = 30mg daily

*** Don’t use if CrCl > 95ml/min = cleared to quickly **
also don’t use < 30 ml/min

43
Q

Warfarin for VTE Treatment

A

cannot be started as monotherapy, must have appropriate bridging with parenteral AC

effective long term management of acute VTE

44
Q

Typical starting dose Warfarin for VTE treatment?

A

5mg po

** 2.5 mg in 65+, frail, malnourished, live/kidney disease, HF, DI

45
Q

Why do we still use warfarin?

A
  • Renal impairemnt
  • Obesity
  • those high risk for bleeding bc they will be monitored frequently
46
Q

Frequency of Warfarin monitoring

A

Inpatient - daily

out of INR range = 2-3 times per week

once stable for 1-2 weeks, every 2-4 weeks up to every 12 weeks

47
Q

Provoked VTE duration of coag

A

3 months regardless of Risk of bleeding

Extend > 3 month if cancer associated or second VTE

48
Q

Unprovoked VTE duration of coag

A

at least 3 months

Proximal DVT or PE, with low-mod risk of bleeding..extend > 3 months

with high risk of bleeding = 3 month

49
Q

For patients at elevated risk of recurrent VTE, how long should they have anticoagulants therapy?

A

6 months atleast

50
Q

Padua Score

A 
>4 = high risk
0-3 = low risk
51
Q

1 pt Padua Score

A 
Age > 70
Heart or Respiratory Failure
Acute MI or ischemic stroke
Acute infection
BMI > 30
Hormonal treatment
52
Q

2 pt Padua Score

A

Recent trauma/surgery < 1 month

53
Q

3 pt Padua Score

A

Active cancer
previous VTE
Reduce mobility
Already known thromboembolic condition

CDM 2 Exam 1 (12 decks)

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