thromboembolism

Question 1

2 type of vte

Answer 1

1) dvt- clot leg
2)PE- clot travel lung

Question 2

HASBLAD (bleeding score)
what score high risk

Answer 2

Hypertension 1
Abnormal/ liver/renal function 1 or 2
stroke 1
bleeding risk1
labile inr1
elderly (>65) 1
drugs concomitant (NSAID/ aspirin) or alcohol 1 0r 2
mx score 9
high risk is greater than of equal to 3

Question 3

dvt Symptoms

Answer 3

unilateral, tender , skin change, local pain , swelling and vein distension

Question 4

PE symptoms

Answer 4

sudden breathless, cough, cough blood, sharp chest pain ,warm in leg/ arm

Question 5

before vte prophylaxis what do you check

Answer 5

Bleeding risk vs clotting risk

Question 6

Bleeding risk factors (5)

Answer 6

1) systolic HTN
2)Anticoagulant
3) bleeding disorder; acquired liver failure, inherited von willebrand, haemophilia
4) thrombocytopenia (low platelet)
5) acute stroke

Question 7

VTE risk assessment

Answer 7

do for all admitted to hospital
- active cnacer
- age>60
- dehydration, significant reduce mobility, HRT, use of oestrogen content oral contraceptive
undergoing - hip / knee replace

Question 8

2 methods prophylaxis

Answer 8

1) pharmacological -anticoag
2) mechanical- anti-embolism stocking and intermittent pneumatic compression

Question 9

what to do if decreased DVT risk and no bleed

Answer 9

ambulation and early mobility

Question 10

inc DVT Risk and low bleed

Answer 10

pharmacological prophylaxis
- LMWH (enoxaparin) , unfracionated heparin (in R), DOAC, fondaparinux ,aspirin

Question 11

high bleed risk , low dvt? what prophylaxis

Answer 11

mechanical (compression and anti embolism stocking)

Question 12

what anticoag preferred in renal impairment and reversal agent

Answer 12

unfractionated heparin- protamine sulphate

Question 13

VTE tx duration in provoked (coc, surgery, pregnancy, leg cast)

Answer 13

3 months (3-6 months active cancer)

Question 14

vte duration tx in unprovoked vte

Answer 14

3 months+ (6m in active cancer)

Question 15

VTE renal impairment tx (crcl 15-50) or normal vte

Answer 15

1. (doac) apixaban/ rivaroxaban
2. lmwh 5+ days follow by dabigatran (if crcl 30+) or edoxaban
   4) lmwh or UH (in RI) + warfarin for 5+ days or until inr 2+ for 2 consecutive reading

Question 16

avoid LMWH in what crcl

Answer 16

<15

Question 17

DURATIOn of pharmacological prophylaxis
1)general surgery/medical patient
2)surgery abdomens
3)spinal surgery

Answer 17

1) 7, 2) 28 3) 30 days

Question 18

duration of mechanical prophylaxis

Answer 18

until sufficient mobile
spinal surgery/ cranial = 30
acute stroke 30 days

Question 19

who to not use anti embolism stocking and how often to wear

Answer 19

PAD, acute stroke or Peripheral neuropathy ,severe leg oedema , gangrene dermatitis

day and night till mobile

Question 20

THROMBOphrophylaxis in knee and hip replacement (pharmacological)

Answer 20

1- rivaroxaban hip:35days, knee:14 days
-if LMWH hip 28 days; knee 14 +anti embolism stocking
-hip: LMWH 10 days+ low dose aspirin 28 days
- knee : low dose aspirin -14 days
alt: dapigatran/ apixaban

Question 21

mechanical compression and which one its used for

Answer 21

knee : pneumatic compression
hip : anti embolism stocking

Question 22

pregnancy thromboprophylaxis

Answer 22

LMWH preferred in preg women + pneumatic compression/ANTIembolism stocking (if immoilised)

preferred as low risk osteoporosis and heparin induced thrombocytopenia stop at onset of labour

Question 23

VTE tx pregnancy

Answer 23

LMWH or (UH IN bleeding risk)

Question 24

reversal agent dabigatran

Answer 24

idarucizumab

Question 25

apixaban/rivaxocaban reversal agent

Answer 25

andaxanet alfa

Question 26

thromboprohylaxis in pharmacacolgical

Answer 26

1st line- doac
2) heparin (UH in RI) alternative fondarinux

Question 27

thromboprohylaxis in mechanical

Answer 27

compression or embolism stocking

Question 28

when to offer mechanical prophylaxis

Answer 28

patients scheduled for surgery till mobile

Question 29

who should have pharmacological vte

Answer 29

high risk VTE - undergoing general/ orthopaedic or admitted to hospital as general medical patients

Question 30

parenteral anticoag

Answer 30

lmwh, UH in renal failure, fondaparinux

Question 31

Heparin (parenteral anticoag) moa

Answer 31

activates antithrombin activates 10a and IIa

Question 32

Unfractionated heparin examples DOA, why preferred, and why essential

Answer 32

Standard heparin, short DOA, preferred when high bleed risk or RI
essential to measure APTT (partial thromboplastin time)

Question 33

LMWH examples, preferred, doa, where used

Answer 33

tinezeparin, enoxaprin, dalteparin
longer doa
preferred choice
lower risk of osteoporosis
heparin induced thrombocytopenia
used- pregnancy

Question 34

s/e heparin

Answer 34

1) haemorrhage- withdraw heparin = rapid reversal
2) hyperkalaemia (inhibit aldosterone secretion high risk dm and ckd monitor before tx and 7 days after
3)osteoporosis
4) heparin induced thrombocytopenia - occurs 5-10 days use, monitor before tx and 4 days after, signs : skin allergy thrombosis

Question 35

interaction heparin

Answer 35

drugs increase hyperkalaemia (had beans)
drugs inc bleeding risk (anticoag - warfarin doac, anti platelet, ssri , nsaid , venlafaxine