Surgical Tut DVT&PE Prevention

Question 1

Virchow’s

Answer 1

stasis
endothelium
hypercoagulable state

Question 2

DVT prophylaxis types?

Answer 2

pharmacological
mechanical
early mobilization

Question 3

bleeding risk for heparin in surgery?

Answer 3

wound haematomas more frequent

no increase in major bleeding risk

Question 4

heparin vs. clexane?

Answer 4

no advantage for anticoagulation

heparin is easier to reverse

Question 5

who is at risk for TED stockings/pneumatic pumps?

Answer 5

patients with severe peripheral vascular disease

thin skin

Question 6

duration of typical prophylaxis Rx? for cancer?

Answer 6

5-7 days or until fully mobile

28-35 days if abdo/pelvic surgery

Question 7

when give clexane after surgery?

Answer 7

usually night of or if higher risk then sooner

Question 8

reversal for warfarin?

Answer 8

prothrombinex: thrombin plus factors, 2,9,10 (25-50/kg)
FFP (one bag matched)

Vitamin K (5-10)

Question 9

mechanical valve risk of anticoagulation?

Answer 9

ok 12-24 hours post-op, it’s not as thrombogenic as we think

Question 10

mechanism of heparin?

Answer 10

activates antithrombin III, inactivates factor Xa

Question 11

aortic or mitral valve replacement mechanical, at higher risk of thromboembolism?

Answer 11

mitral

Question 12

how does clopidogrel work?

Answer 12

blocks P2Y12 receptor on platelets, block response to ADP

Question 13

bare metal stends how long?

Answer 13

aspirin lifetime

Question 14

riveroxiban mechanism?

Answer 14

factor Xa inhibitos

Question 15

how to reverse dabigatran?

Answer 15

haemofiltration

Question 16

NOACs wait how long before surgery?

Answer 16

24-48hours waitw

Question 17

thrombectomy for DVT?

Answer 17

not really?

Question 18

when use IVC filter?

Answer 18

if can’t use anticoags
recurrent PEs
with anticoags if high risk of PE: poorly tolerated

Question 19

risk factors for DVT, less known ones

Answer 19

pregnancy
central venous ilne
varicose veins
shock