Maintenance tx of acute VTE

Question 1

Anticoagulation in labour/delivery

Answer 1

• When VTE occurs at term, consideration should be given to the use of intravenous unfractionated
  heparin which is more easily manipulated.
• Regional anaesthetic or analgesic techniques should not be undertaken until at least 24 hours after the last dose of therapeutic LMWH.
• LMWH should not be given for 4 hours after the use of spinal anaesthesia or after the epidural catheter has been removed, and the epidural catheter should not be removed within 12 hours of the most recent injection.

Question 2

When do you give protamine sulphate?

Answer 2

When APTT prolonged in pts taking unfractionated heparin

Question 3

What are the surgical techniques to use in patients on LMWH?

Answer 3

• drain at caesarean section
• ## interrupted stitches on the skin

Question 4

What is post thrombotic syndrome?

Answer 4

• Chronic persistent leg swelling
• Pain,
• Feeling of heaviness
• Dependant cyanosis
• Telangiectasis
• Chronic pigmentation
• Eczema,
• Associated varicose veins and in the most severe cases, venous ulceration.
• Compression stocking need to be worn for at least 2 years to reduce the risk