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Obstetrics > Thromboembolism > Flashcards

Thromboembolism Flashcards

1
Q

When is the highest risk for VTE during pregnancy?

A

Postpartum! Weeks following delivery

Third tri is greater risk than 1st/2nd tri

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2
Q

Most common thrombophilia?

A

Factor V Leiden Mutation

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3
Q

High Risk Thrombophilias

A

Factor V Leiden HOMOzygote
Prothrombin Mutation HOMOzygote
*Heterozygous for both conditions
Antithrombin Deficiency

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4
Q

Low Risk Thrombophilias

A

Factor V HETERozygote
Prothrombin Mutation HETERozygote
Protein C Deficiency
Protein S Deficiency
Antiphospholipid Antibody

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5
Q

Tx of VTE while pregnant

A

Theraputic dosing LMWH fpr 3-6 months, continue PPx dosing after this and for 6 wks postpartum

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6
Q

Tx for Hx of PROVOKED DVT in past (not estrogen related)

A

Antepartum surviellence
+/- PPx dosing for 6 wks PP

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7
Q

Tx for Hx of UNPROVOKED DVT in the past

A

PPx or theraputic LMWH antepartum
Continue 6 wks PP

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8
Q

Tx for Low risk thrombophilia
No prior DVT
No FmHx DVT

A

Antepartum surviellence
+/- PPx dosing for 6 wks PP if risk factors

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9
Q

Low Risk Thrombophilia
w/ FmHx of DVT (first degree)

A

Surviellence or PPx dosing antepartum
PPx dosing for 6 wks PP

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10
Q

Tx for High Risk Thrombophilia
w/ no Hx of DVT

A

PPx dosing antepartum and for 6 wks PP

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11
Q

High risk thrombophilia w/ hx of VTE

A

Theraputic dosing antepartum, continue for 6wk PP

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12
Q

When should anticoagulation begin postpartum?

A

4-6h after vaginal delivery
6-12h after C/S

  • Consider if they had neuraxial blockade
  • PPx or low dose LMWH (12h after placement, 4h after removal)
  • Intermediate/Adjusted dose LMWH (24h after placement, 4h after removal)
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13
Q

Do Unfractionated Heparin and LMWH cross the placenta?

A

Nope!

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14
Q

Can you used direct thrombin inhibitors or Factor Xa inhibitors in pregnancy?

A

Not recommended!! Insufficient evidence - THEY DO CROSS the placenta

*Detectable in breast milk as well!

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15
Q

When is Warfarin acceptable in pregnancy?

A

In women with mechanical heart valves due to high risk of thrombus despite heparin

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16
Q

Anticoagulation in pregnant patient with suspected HIT?

A

Fondaparinux preferred agent

= enhances activity of antithrombin, but only enhances degradation of 10a

17
Q

Clotting risk in pregnancy of Factor V Leiden + Hx personal hx of VTE?

A

Risk is 10%

18
Q

What procoagulants increase in pregnancy?

A

All except
Factor 2, 5 and 9 STAY THE SAME

19
Q

What anticoagulants decrease in prengnacy?

A

Protein S decreases

Protein C stays the same
Antithrombin stays the same

20
Q

Dosing for PPx, intermediate and adjusted dose LMWH?

A

PPx 40 mg Daily
Intermediate 40 mg BID
Adjusted Dose = 1 mg/kg Q12

21
Q

Dosing for PPx, and adjusted dose UFH?

A

PPx 5-10K units daily
Adjusted Dose > 10K Q12h

22
Q

Best diagnostic imaging modality for a patient with renal insufficiency?

A

VQ scan

23
Q

What gestational age is most appropriate to transition from LMWH to UFH?

A

36-37w

24
Q

What thrombophilia test is NOT reliable during prengnacy?

A

Protein S

25
Q

What thrombophilia test is NOT reliable with active clot?

A

Protein C

Antithrombin

26
Q

Most important risk factor for developing VTE in pregnancy?

A

Hx of thrombosis

27
Q

What is the MOST appropriate management of a pregnant patient with a heterozygous mutation for factor V Leiden mutation?

A

Surveillance w/ out anticoagulation

28
Q

Which of the following is the BEST medication to reverse the effects of heparin

A

Protamine Sulfate

29
Q

By how much does a personal history of venous thromboembolism (VTE) increase the risk of VTE in pregnancy

A

3-fold to 4-fold

30
Q

What is the increased risk of VTE in pregnant/PP patients compared to non-pregnant?

A

Pregnant/Postpartum women have a 4-5 fold increased risk

31
Q

What is the BEST estimate of risk of venous thromboembolism (VTE) in a pregnant patient who is heterozygous for factor V Leiden mutation with a personal history of VTE?

A

10%

32
Q

Most common presenting sign of DVT in pregnancy?

A

PAIN + swelling

33
Q

Target anti-Xa level for LMWH when using weight based/adjusted dose? When should it be drawn?

A

4 hours after injection
Target = 0.6-1.0 units/ml

34
Q

MOA of Heparin

A

Co factor for antithrombin
Increases inhibition of thrombin and Factor Xa

35
Q

What lab helps to monitor Heparin? What is the theraputic goal?

A

PTT
1.5-2.5 x control

36
Q

Reversal agent for Heparin? Dosing?

A

Protamine Sulfate
1 mg/100 U heparin

37
Q

Heparin PPx dosing?

A

5,000 units BID

38
Q

Benefits of LMWH compared to Heparin?

A

Longer half life (easier dosing)
Decreased risk of HIT

No reversal

Still need to monitor: Anti Xa Q4-6 wks during pregnancy
Draw lab 4 hours after dosing

Obstetrics (26 decks)

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