Pathophys of VTE

Question 1

3 natural anticoagulants

Answer 1

Antithrombin (inhibits proteases)
Tissue factor pathway inhibitor (inhibits proteases, mainly VIIa/TF)
Thrombomodulin and protein C/S (breakdown coenzymes - V and VIII)

Question 2

4 VTE diseases

Answer 2

Superficial vein thrombosis
Migratory superficial vein thrombosis
DVT
DVT complications (PE, postthrombotic syndrome, recurrence)

Question 3

Acquired risks/etiology of VTE

Answer 3

Immobility
Age
Pregnancy
Obesity
Trauma
Surgery
Malignancy
Meds (OCP)
Inflammation
Hyperviscosity
Antiphospholipid antibody syndrome

Question 4

5 hereditary causes of VTE

Answer 4

Factor 5 Leiden (resistant to degradation)
Prothrombin gene mutation
Protein C deficiency
Protein S deficiency 
Antithrombin deficiency

Question 5

Virchow’s triag

Answer 5

Vascular injury
Stasis
Hypercoagulability

Question 6

Signs of DVT

Answer 6

Swelling
Pain
Red
Warm
More commonly unilateral but can be in both legs

Question 7

Signs of PE

Answer 7

Typical: SOB, chest pain (pleuritic), hemoptysis
Atypical: abdominal pain, syncope, fever, cough, seizure

Question 8

Signs of Postthrombotic syndrome

Answer 8

Swelling
Pain
Ulcers
Rash

Question 9

2 radiologic testing modalities

Answer 9

Ultrasound (better for proximal)
Spiral CT (most common test for PE)

Question 10

Treatment

Answer 10

Heparin + Warfarin
5 day or more overlap
Heparin (IV/SC) acts more rapidly
Warfarin (PO) acts slower and has a transient procoagulant state

Question 11

How long do you have to treat for

1. DVT
2. PE

Answer 11

1. 3-6 months
2. 6-12 months
   Potentially indefinite if recurrence risk is sufficiently high