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Cardiovascular Disease > Thromboembolism > Flashcards

Thromboembolism Flashcards

1
Q

When would a VTE be considered hospital-acquired?

A

If it occurs within 90 days of hospital admission

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2
Q

Risk factors for VTE

A

Surgery
Trauma
Significant immobility e.g., hospitalisation or long haul flight
Malignancy
Obesity
Pregnancy and postpartum period
Hormonal therapy (COC or HRT)

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3
Q

Symptoms of DVT

A

Swelling
Hot to touch
Painful
One leg
Unilateral localised pain
If DVT dislodged can lead to PE

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4
Q

Symptoms of PE

A

SOB
Coughing
Chest pain

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5
Q

Diagnostic test for VTE

A

D-dimer

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6
Q

VTE prophylaxis

A

Mechanical - compression stockings
Pharmacological

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7
Q

Within how many hours of admission should pharmacological VTE prophylaxis be started?

A

14 hours

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8
Q

What VTE prophylaxis is used in a general / orthopaedic surgical patient?

A

Mechanical
Pharmacological with LMWH

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9
Q

Which pharmacological VTE prophylaxis is preferred in patients with renal impairment?

A

Unfractionated heparin

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10
Q

Which pharmacological VTE prophylaxis is preferred in patients at high risk of bleeding and why?

A

Unfractionated heparin
Shorter half-life

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11
Q

Which pharmacological VTE prophylaxis is preferred in patients with lower limb immobilisation (knee replacement) or pelvis fragility fractures, or cardiac / bariatric surgery?

A

Fondaparinux sodium

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12
Q

For how long after surgery is pharmacological therapy generally continued?

A

At least 7 days or until sufficient mobility has been reestablished

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13
Q

For how long after cancer surgery in the abdomen should VTE prophylaxis be continued?

A

28 days

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14
Q

For how long after spinal or cranial surgery should VTE prophylaxis be continued?

A

30 days

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15
Q

For how long after elective hip replacement surgery should VTE prophylaxis be continued? Which drugs are used?

A

LMWH for 10 days then low-dose aspirin for 28 days
LMWH for 28 days in combination with stockings until discharge
Rivaroxaban

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16
Q

For how long after elective knee replacement surgery should VTE prophylaxis be continued? Which drugs are used?

A

75mg aspirin for 14 days
LMWH for 14 days in + stockings until discharge
Rivaroxaban
Apixaban or Dabigatran can be considered as alternatives

17
Q

VTE prophylaxis for general medical patients

A

LMWH min 7 days
Fondaparinux min 7 days
Renal impairment = unfractionated heparin

18
Q

VTE prophylaxis in acute stroke patients

A

Mechanical stockings - started within 3 days and continued for 30 days post stroke or until sufficiently mobile

19
Q

VTE prophylaxis in pregnancy (duration and risk factors)

A

Women who have given birth, had a miscarriage or termination of pregnancy during the past 6 weeks - start LMWH within 4-8 hours and continued for a min of 7 days

Continued until there is no longer VTE risk or until discharge

Additional mechanical prophylaxis if immobilised until sufficiently mobile or discharged from hospital

20
Q

Baseline blood tests when starting anticoagulation treatment

A

FBC
Renal function
Hepatic function
Coagulation screening - Prothrombin time

21
Q

Treatment of confirmed proximal DVT or PE

A

1st: Apixaban or Rivaroxaban
2nd: LMWH for at least 5 days followed by Dabigatran or Edoxaban
3rd: LMWH and warfarin for at least 5 days or until INR is 2.0 for 2 consecutive readings then warfarin by itself

22
Q

Treatment of confirmed proximal DVT or PE with renal impairment (CrCl 15-50ml/min)

A

1st: Apixaban or Rivaroxaban
2nd: LMWH for at least 5 days followed by Dabigatran (if CrCl >30ml/min) or Edoxaban
3rd: LMWH or unfractionated heparin and warfarin for at least 5 days or until INR is 2.0 for 2 consecutive readings then warfarin by itself

23
Q

Duration of confirmed proximal DVT or PE treatment

A

Min. 3 months

24
Q

Duration of confirmed provoked DVT or PE treatment

A

Consider stopping at 3 months if the provoking factor is no longer present

25
Q

Duration of confirmed proximal/provoked DVT or PE treatment in patients with active cancer

A

3-6 months

26
Q

Duration of confirmed unprovoked DVT or PE treatment

A

> 3 months

27
Q

Duration of confirmed unprovoked DVT or PE treatment in patients with active cancer

A

6 months

28
Q

Bleeding risk tools

A

ORBIT
HASBLED

29
Q

Patient factors to exclude continuing treatment with an anticoagulant?

A

Provoked DVT/PE
Renal impairment
Active cancer
Extreme bodyweight

30
Q

Management if current treatment is not well tolerated

A

Switch to apixaban
Consider aspirin for those who decline anticoagulation

31
Q

Duration of treatment for distal CVT in calf

A

6 weeks

32
Q

Treatment of confirmed DVT/PE in pregnant women

A

LMWH
Unfractionated heparin if at high risk of haemorrhage

33
Q

Heparin antidote

A

Protamine sulfate

Cardiovascular Disease (11 decks)

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