thromboembolism Flashcards
2 type of vte
1) dvt- clot leg
2)PE- clot travel lung
HASBLAD (bleeding score)
what score high risk
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
dvt Symptoms
unilateral, tender , skin change, local pain , swelling and vein distension
PE symptoms
sudden breathless, cough, cough blood, sharp chest pain ,warm in leg/ arm
before vte prophylaxis what do you check
Bleeding risk vs clotting risk
Bleeding risk factors (5)
1) systolic HTN
2)Anticoagulant
3) bleeding disorder; acquired liver failure, inherited von willebrand, haemophilia
4) thrombocytopenia (low platelet)
5) acute stroke
VTE risk assessment
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
2 methods prophylaxis
1) pharmacological -anticoag
2) mechanical- anti-embolism stocking and intermittent pneumatic compression
what to do if decreased DVT risk and no bleed
ambulation and early mobility
inc DVT Risk and low bleed
pharmacological prophylaxis
- LMWH (enoxaparin) , unfracionated heparin (in R), DOAC, fondaparinux ,aspirin
high bleed risk , low dvt? what prophylaxis
mechanical (compression and anti embolism stocking)
what anticoag preferred in renal impairment and reversal agent
unfractionated heparin- protamine sulphate
VTE tx duration in provoked (coc, surgery, pregnancy, leg cast)
3 months (3-6 months active cancer)
vte duration tx in unprovoked vte
3 months+ (6m in active cancer)
VTE renal impairment tx (crcl 15-50) or normal vte
- (doac) apixaban/ rivaroxaban
- 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
avoid LMWH in what crcl
<15
DURATIOn of pharmacological prophylaxis
1)general surgery/medical patient
2)surgery abdomens
3)spinal surgery
1) 7, 2) 28 3) 30 days
duration of mechanical prophylaxis
until sufficient mobile
spinal surgery/ cranial = 30
acute stroke 30 days
who to not use anti embolism stocking and how often to wear
PAD, acute stroke or Peripheral neuropathy ,severe leg oedema , gangrene dermatitis
day and night till mobile
THROMBOphrophylaxis in knee and hip replacement (pharmacological)
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
mechanical compression and which one its used for
knee : pneumatic compression
hip : anti embolism stocking
pregnancy thromboprophylaxis
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
VTE tx pregnancy
LMWH or (UH IN bleeding risk)
reversal agent dabigatran
idarucizumab
apixaban/rivaxocaban reversal agent
andaxanet alfa
thromboprohylaxis in pharmacacolgical
1st line- doac
2) heparin (UH in RI) alternative fondarinux
thromboprohylaxis in mechanical
compression or embolism stocking
when to offer mechanical prophylaxis
patients scheduled for surgery till mobile
who should have pharmacological vte
high risk VTE - undergoing general/ orthopaedic or admitted to hospital as general medical patients
parenteral anticoag
lmwh, UH in renal failure, fondaparinux
Heparin (parenteral anticoag) moa
activates antithrombin activates 10a and IIa
Unfractionated heparin examples DOA, why preferred, and why essential
Standard heparin, short DOA, preferred when high bleed risk or RI
essential to measure APTT (partial thromboplastin time)
LMWH examples, preferred, doa, where used
tinezeparin, enoxaprin, dalteparin
longer doa
preferred choice
lower risk of osteoporosis
heparin induced thrombocytopenia
used- pregnancy
s/e heparin
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
interaction heparin
drugs increase hyperkalaemia (had beans)
drugs inc bleeding risk (anticoag - warfarin doac, anti platelet, ssri , nsaid , venlafaxine
