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?

23
Q

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

24
Q

What thrombophilia test is NOT reliable during prengnacy?

25
What thrombophilia test is NOT reliable with active clot?
Protein C | Antithrombin
26
Most important risk factor for developing VTE in pregnancy?
Hx of thrombosis
27
What is the MOST appropriate management of a pregnant patient with a heterozygous mutation for factor V Leiden mutation?
Surveillance w/ out anticoagulation
28
Which of the following is the BEST medication to reverse the effects of heparin
Protamine Sulfate
29
By how much does a personal history of venous thromboembolism (VTE) increase the risk of VTE in pregnancy
3-fold to 4-fold
30
What is the increased risk of VTE in pregnant/PP patients compared to non-pregnant?
Pregnant/Postpartum women have a 4-5 fold increased risk
31
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?
10%
32
Most common presenting sign of DVT in pregnancy?
PAIN + swelling
33
Target anti-Xa level for LMWH when using weight based/adjusted dose? When should it be drawn?
4 hours after injection Target = 0.6-1.0 units/ml
34
MOA of Heparin
Co factor for antithrombin Increases inhibition of thrombin and Factor Xa
35
What lab helps to monitor Heparin? What is the theraputic goal?
PTT 1.5-2.5 x control
36
Reversal agent for Heparin? Dosing?
Protamine Sulfate 1 mg/100 U heparin
37
Heparin PPx dosing?
5,000 units BID
38
Benefits of LMWH compared to Heparin?
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