Thromboembolism Flashcards
1
Q
DVT
A
blood clot in deep vein, calf or one leg
2
Q
PE
A
Detachment of blood clot which travels to the lungs and blocks the pulmonary artery
3
Q
VTE risk assessment
A
- Immobile
- Obesity
- malignant disease
- 60+ years
- Hx of VTE / family Hx VTE
- HRT / combined contraception
- varicose veins with phlebitis
- pregnancy
- critical care
- co-morbidities
4
Q
Risk of bleeding
A
- thrombocytopenia (low platelt)
- acute stroke
- bleeding disorders
- acquired: liver failure
- inherited: haemophilia, von Willebrand disease (poor ability for blood to clot) - anticoagulation
- systolic hypertension
5
Q
Mechanical VTE prophylaxis
A
compression stockings
for patients scheduled surgery continued until sufficient mobility
6
Q
Pharmacological VTE prophylaxis
A
HIGH RISK
SURGERY
ADMITTED TO HOPSITAL
- Parental anticoagulants
- LMWH
- Unfractionated heparin in renal failure
- Fondaparinux
7
Q
Duration of VTE prophylaxis
A
General surgery = 5-7 days or until mobile
Major cancer surgery in abdo/pelvis = 28 days
Knee/Hip surgery = extended
8
Q
Treatment of VTE
A
- LMWH or unfractionated heparin in renal failure = at least 5-days or until INR >2 for atleast 24hrs. Monitor APTT if unfractionated heparin given
- Start oral anticoagulant at same time (usually warfarin)
9
Q
VTE in pregnancy
A
- LMWH
- lower risk of OP and heparin-induced thrombocytopeonia
- stop at labour-onset
- seek specialist advice on continuing after birth
10
Q
HEPARIN
A
Unfractionated heparin
- Activates antithrombin
- shorter duration of action
- preferred choice if 1. higher bleeding risk 2. renal impairment
- essential to measure APTT (activated partial thromboplastin time)
LMWH
- inactive factor Xa
- e.g. tineprin, enoxaprin, dalteparin
- longer duration of action
- preferred choice as lower risk of: OP, heparin-induced thrombocytopenia
- used in pregnancy
