PE II

Question 1

absolute contraindications to AC?

Answer 1

recent surgery
active bleeding
intracranial pathology like tumors
aortic dissection
severe HTN
recent neuraxial

Question 2

AC used?

Answer 2

LMWH, DOAC

heparin: Bolus + infusion vs infusion only

Question 3

 Preferred agent overall if
oral AC not feasible

 BID subcutaneous
injections

 Preferred:
◼ Cancer
◼ Pregnancy

 Precautions
◼ Severe renal dysfunction

Answer 3

Parenteral anticoagulants

Question 4

Parenteral anticoagulants?

alternatives?

Answer 4

 Unfractionated heparin

 IV Bolus + infusion
◼ For rapid anticoagulation

 Infusion only without
bolus
◼ For patient with bleeding
risk

 Follow PTT or Anti-Xa
level

***fondaparinux

Question 5

Oral anticoagulants (DOACs)?

contraindications?

Answer 5

 DOACs are preferable if
oral agents are an option:
-Rivaroxaban
-Apixaban

**pregnancy and severe renal failure

Question 6

Why is warfarin NOT a
good choice for urgent
anticoagulation?

Answer 6

24-72 hrs to work

Question 7

Anticoagulant agents for acute PE (in general)?

Answer 7

 Hospital/ICU:
 Unfractionated heparin
 Low molecular weight
heparin

 Emergency Department:
 DOACs: Rivaroxaban and apixaban
 LMWH

Question 8

main options for initial anticoagulation?

Answer 8

unfractionated heparin

Question 9

Preferred agents for special

populations?

Answer 9

unfractionated heparin

LMWH

Question 10

long term anticoagulation?

Answer 10

oral anticoagulation (DOAC), mores than warfarin(used as alternative if DOAC not used and requires close monitoring)

Question 11

types of repercussion therapy?

Answer 11

thrombolysis

embolectomy

Question 12

alternatives to anticoagulation therapies for PE?

Answer 12

IVC filter

Question 13

mortality of PE?

Answer 13

2-11% if AC given

Question 14

recurrence of PE?

major predictors of recurrence?

Answer 14

2 percent at two weeks
6 percent at three months

stimuli, cancer and thrombotic disorders and failure to achieve therapeutic levels

Question 15

late mortality due to?

Answer 15

malignancy
sepsis
MI/HF
stroke

Question 16

recurrence due to late complications?

when would CTEPH occur?

Answer 16

8% at 6 month to 30% at 10 yrs

within 2 yrs of initial PE

Question 17

how to diagnosis CTEPH?

tx?

Answer 17

ventilation perfusion lung scan

pulmonary artery catheterization

pulmonary angiogram

***lifelong anticoagulant therapy, pulmonary thromboendoarterectomy

Question 18

duration of anticoagulation?

Answer 18

if first episode of provoked or unprovoked VTE, AC for minimum of 3 months

*this includes distal DVT and small sub segmental PE

but if have provoked VTE but reversible risk factors and low bleeding risk emend to 6-12 months, h/e if cancer is present than indefinite***