Thromboembolic Disorders Flashcards
SAID WE MIGHT SEE THIS ON TEST:
EKG changes seen with PE
S1, Q3, inverted T3
nonspecific ST changes
right bundle branch branch block
right axis deviation
SAID WE MIGHT SEE THIS ON TEST:
chief side effect of unfractionated heparin treatment
osteoporosis
SAID WE MIGHT SEE THIS ON TEST:
Treatment for HIT
protamine sulfate
when are thromboembolitic events most likely to occur in pregnancy
equal distribution in all 3 trimesters
pregnancy is a hypercoagulable state. how? (6)
- venous stasis due to
a. compression of IVC and pelvic veins and
b. increased capacitance of vessels (effect of estrogen, prostacylin, and NO, which are all elevated in pregnancy ) - increased progesterone
- doubling of fibrinogen levels
- in in factors 7, 8, 9, 10, 12 (up 1000%)
- vWF levels increase 400%
- decrease in protein S (= resistance to protein C)
alterations that make pregnancy a hyper coagulable state return to baseline when?
6 weeks postpartum
what are pregnancy specific risk factors for developing a thromboembolic disease
increased parity
postpartum endomyometritis
operative delivery with forceps or vacuum
C/S (9x more risk)
what is required for diagnosis of anti-phospholipid Ab syndrome in pregnancy
presence or prior venous thromboembolus/obstetric complication (i.e. a bunch of misscarriages)
AND
at least one lab criterion (anticardiolipn Ab or lupus anticoagulant) present on 2 occasions at least 6 weeks apart
All inherited thrombophillias are __(mode of inheritance)__ except _____
AD except hyperhomocysteninemia
how are DVTs diagnosed in pregnancy
venous ultrasound: noncompressibility of venous lumen in transverse plane under gentle probe pressure with duplex and color flow doppler
MRIs but expensive and don’t have easy access
_____ has 100% specificity and sensitivity for DVT but cannot be used in 20% of pts due to…
contrast venography
intolerance to the dye
signs and symptoms of PE
tachycardia and tachypnea and low O2 stats
CXR see in with PE
pleural effusions, atelectasis, elevated hemidiaphragm, pulm infiltrate
preferred method of screening and diagnostic modality for PE
spiral CT
enhances ATII activity + increases Xa inhibitor activity + inhibits platelet aggragation
unfractionated heparin
chief side effect of unfractionared heparin
hemorrhage, osteoporosis, thrombocytopenia (HIT)
2 types of HIT and how they are different
I: most common, self limited and occurs w/in days–no signifiant risk of thrombosis
II: ocurrs 5-14 days, inc risk of thrombosis, 50% decline in platelet ct from pretreatment max
inactivates Xa but not thrombin
fondaparinux
why do you switch pts to unfractionated heparin after 36 weeks
there is suboptimal reversal with protamine sulfate = safer to use unfractionated
vtiamin K antagonist
warfarin
is warfarin safe to use in pregnancy
no but safe during lactation
effects of warfarin on fetus
greatest effect btwn 6-12 weeks: nasal and midface hypoplasia microphthalmia mental retardation other ocular, skeletal and CNS malformations fetal hemorrhage
why does warfarin treatment need to be backed up with anti-coagulation
cuases prothrombotic state for first 72 hrs of treatment due to depletion of protein C
synthetic heparin that competes with ATIII binding site
fondaparinux
