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Pre Reg Exam > Thromboembolism > Flashcards

Thromboembolism Flashcards

1
Q

What is thromboembolism?

A

Formation of blood clot (thrombus)
Obstruct blood vessels

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2
Q

Two types of VTE?

A

Dvt- deep vein thrombosis
PE - pulmonary embolism

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3
Q

What is DVT?

A

Formation of blood clot in deep veins like limbs, pelvis, legs

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4
Q

What is PE

A

Blood clot from DVT travels to blood causing obstruction in pulmonary artery

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5
Q

List symptoms of DVT?

A

Tenderness
Swelling
Localized Pain
Skin changes
Vein distension (neck vein swollen?

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6
Q

List symptoms of PE

A

SOB
Chest pain
Haemoptysis (coughing)

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7
Q

What are the risk factors of DVT

A

Cancer
Pregnancy
Postpartum
Trauma
Surgery
Immobility
>65years
Obesity
Smoking

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8
Q

List the two types of DVT and explain them

A

Provoked - there is known risk factors
Unprovoked - we don’t know the risk factors

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9
Q

What type of treatment does unprovoked DVT requires?

A

Long term anticoagulant to prevent reoccurrence

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10
Q

What are the two test used to diagnose DVT?

A

Well score
D-dimer

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11
Q

What is wells score?

A

Prediction tool used to estimate the probability that a pt might have DVT or PE

(10-DVT, 7-PE)

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12
Q

What is D-dimer test?

A

Blood test used to detect presence of elevated levels of substances (D-dimer). They are protein fragments made when blood clot is dissolved in your body

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13
Q

Can you do ultrasound to detect DVT and when should you do it?

A

Yes
Within 4 hours onset ideally

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14
Q

A positive ultrasound confirm DVT. True or false?

A

True

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15
Q

After DVT, what is the non drug treatment used to manage leg symptoms?

A

Elastic graduated compression stockings

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16
Q

When can you not use elastic compression stockings?

A

VTE reoccurrence after DVT
Preventing post thrombotic syndrome

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17
Q

What is the first line treatment after confirmed DVT or PE?

A

Anticoagulant - Apixaban, Rivaroxaban

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18
Q

If anticoagulants are not suitable or tolerated, what do you give?

A

Low molecular weight heparin (enoxaparin, dalteparin sodium, tinzaparin) for Atleast 5 days followed by edoxaban or dabigatran

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19
Q

Continuation of LMWH trt

A

Lmwh with vitamin k antagonist (warfarin) for atleast 5 days or until INR is atleast 2.0 for two consecutive reading then you’ll just take vitamin k antagonist alone

20
Q

When can you only use unfractionated heparin with warfarin?

A

Renal impairment
Renal failure
Inc risk of bleeding

21
Q

What do you give if creatine level is <15ml/min?

A

LMWH or
Unfractionated heparin

22
Q

How many days is the peak therapeutic effect of warfarin after initiation?

A

5 to 7 days

23
Q

How long is the treatment for provoked DVT or PE?

A

Atleast 3 months (3-6 months for active cancer)

24
Q

What is thrombophillia?

A

Multifactorial condition where the blood has an increase chance to clot

25
Q

What is Factor V Leiden?

A

Genetic mutation, makes people more prone to developing abnormal blood clots in veins. Eg Europeans

26
Q

What is the main complication of DVT?

A

Leads to PE- which leads to death

27
Q

What do you give pregnant women with suspected VTE?

A

LMWH- enoxaparin, etc

28
Q

If you are at high risk of haemorrphage, what should you give?

A

Intravenous heparin

29
Q

What do you give people who are allergic to heparin or develop heparin induce thrombocytopenia?

A

Give alternative anticoagulants

30
Q

What else can you use unfractionated heparin for?

A

Maintenance of extracorporeal circuits in hemodialysis and cardiopulmonary bypass

31
Q

What do you use for the reversal of heparin effect?

A

Protamine sulfate
(Only partial reverse the effect)

32
Q

Anyone admitted to the hospital is at high risk of VTE, true of false? What do you do when they come in?

A

True

Assess them to see if suitable to start prophylactic anticoagulants

33
Q

What is the prophylactic anticoagulant treatment giving to those at risk of VTE after being admitted?

A

Anticoagulant with LMWH heparin like tinzaparin

34
Q

List two underlying causes of unprovoked PE?

A

Malignancy
Inherited thrombophillia

35
Q

What is PESI score used for prognosis?

A

(Pulmonary embolism severity index)

It helps to predict patients 30 days mortality.

It guides to the appropriate treatment

36
Q

How many severity classes are they in PESC score and which one is the highest?

A

IV classes

IV is the highest (>125)

37
Q

What do you give for haemodynamic instability in PE

A

Thrombolysis - Alteplase

10mg IV bolus then
90mg IV infusion over 2 hours

38
Q

What do you give for stable haemodynamic but patient is hypotensive

A

Noradrenaline or
Dobutamine 2.5-10mcg

39
Q

What should women who have given birth/miscarriage/termination be given as prophylaxis and for how long?

A

LMW heparin 4-8 hours after the event and continue for minimum of 7 days

40
Q

What is the first and second line mechanical prophylaxis for immobilized woman?

A

Intermittent pneumatic compression

Or anti embolism stockings

41
Q

What is the first/second option for pharmacological prophylaxis? And for how long?

A

LMW heparin or
Fondaparinux sodium

Used for minimum of 7 days

42
Q

What prophylaxis should be given for people with renal impairment?

A

LMW heparin or unfractionated heparin

43
Q

What prophylaxis can you give for people undergoing abdominal, thoracic, cardiac surgery or immobilization?

A

Fondaparinux

44
Q

How long should prophylaxis be given in major cancer surgery in abdomen?

A

28 days

45
Q

How long should prophylaxis be given in spinal surgery?

A

30 days

46
Q

What prophylaxis should be given for pt undergoing elective knee replacement?

A

Low dose aspirin for 14 days
Or LMW heparin with anti embolism stockings for 14days until discharge
Or rivaroxaban

Not not appropriate give apixaban ot dabigatran

Pre Reg Exam (11 decks)

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