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PR - CARDIOVASCULAR SYSTEM > THROMBOEMBOLISM > Flashcards

THROMBOEMBOLISM Flashcards

1
Q

Types of thromboembolism

A

DVT
PE

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2
Q

VTE

A

Blood clot in vein
obstructs blood flow

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3
Q

DVT

A

Blood clot occurs in a deep vein
leg or pelvis
Unilateral localised pain or swelling
Typically in the calf of one leg.

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4
Q

Pulmonary Embolism (PE)

A

Blood clot detaches and travels to the lungs and blocks the pulmonary artery.
Chest pain
Shortness of breath

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5
Q

Risk factors of VTE

A

Surgery
Trauma
Significant immobility
Malignancy
Obesity
Pregnancy
Hormonal Therapy (COC or HRT)

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6
Q

How to diagnose VTE

A

D-dimer test for diagnosis

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7
Q

Methods of thromboprophylaxis (2)

A

Mechanical - graduated compression stockings
Pharmacological - anticoagulants

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8
Q

Mechanical thromboprophylaxis

A

Graduated Compression Stockings
* Wear until the patient is sufficiently mobile

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9
Q

Pharmacological thromboprophylaxis

A

Anticoagulants
Start within 14 hours of admission
Patients with risk factors for bleeding should only receive pharmacological prophylaxis when their risk of VTE outweighs their risk of bleeding

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10
Q

VTE Prophylaxis - surgery

A

Mechanical - graduated compression stockings
Pharmacological - anticoagulants

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11
Q

Mechanical prophylaxis - surgery

A

Prophylaxis should continue until the patient is sufficiently mobile or discharged from hospital

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12
Q

Pharmacological prophylaxis - surgery

A

Considered when the risk of VTE outweighs the risk of bleeding

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13
Q

Surgery - type of anticoagulant

A

LMWH - suitable in all types of general and orthopaedic surgery
Unfractionated heparin - preferred in renal impairment
Fondaparinux sodium - lower limb immobilisation or pelvis fragility fractures

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14
Q

Unfractionated heparin vs LMWH

A

if we need to stop fluidity of their blood quickly

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15
Q

Surgery - how long do we continue VTE prophylaxis for?

A

Continue for at least 7 days post-surgery, or until sufficient mobility has been re-established
28 days after major cancer surgery in the abdomen
30 days in spinal surgery

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16
Q

Elective hip replacement either:

A

LMWH for 10 days and then 75mg aspirin for 28 days
LMWH for 28 days in + stockings until discharge
Rivaroxaban

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17
Q

Elective knee replacement either:

A

75mg aspirin for 14 days
LMWH for 14 days in + stockings until discharge
Rivaroxaban

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18
Q

General medical patients with high risk of VTE

A

should be given pharmacological prophylaxis for at least 7 days or mechanical prophylaxis until mobile

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19
Q

VTE prophylaxis - Pregnancy high risk of VTE

A

If risk of VTE that outweighs the risk of bleeding
* LMWH during hospital admission
* Pregnant women: prophylaxis until no risk of VTE or till patient discharged

20
Q

Women who have given birth, had a miscarriage or termination of pregnancy during the past 6 weeks →

A

start LMWH 4-8 hours after the event → continue for a minimum of 7 days

21
Q

Pregnancy - Additional mechanical prophylaxis if immobilised →

A

until sufficiently mobile or discharged from hospital

22
Q

Treatment of VTE: pregnancy

A

LMWH; unfractionated if patient is at high risk of haemorrhage (unfractionated = short half life)

23
Q

VTE Treatment

A

Confirmed proximal DVT or PE: Apixaban or Rivaroxaban

24
Q

VTE Treatment - if rivaroxaban or apixaban unsuitable

A

If unsuitable offer:
(LMWH) for at least 5 days followed by Dabigatran or Edoxaban
LMWH + warfarin for at least 5 days or until the INR is at least 2.0 for 2 consecutive readings, followed warfarin alone

25
Q

Duration of treatment - VTE treatment

A

Distal DVT (calf): 6 Weeks
Proximal DVT / PE: At least 3 months (3 to 6 months for those with active cancer)
Provoked DVT / PE: Stop at 3 months if the provoking factor resolved
Unprovoked DVT / PE: 3 Months +
Recurrent DVT / PE: Longterm

26
Q

Warfarin - maintain INR of 2.5

A

VTEs, AF, Cardioversion, MI, Cardiomyopathy

27
Q

Warfarin -Maintain INR of 3.5

A

Recurrent VTEs or mechanical heart valves

28
Q

Warfarin - major bleed

A

Stop warfarin - IV phytomenadione and dried prothrombin

29
Q

INR >8, minor bleeding:

A

Stop warfarin - IV phytomenadione

30
Q

INR >8, no bleeding:

A

Stop warfarin - oral phytomenadione

31
Q

INR 5-8, minor bleeding

A

Stop warfarin - IV phytomenadione

32
Q

INR 5-8, no bleeding:

A

Withhold 1-2 doses of warfarin

33
Q

When should you restart warfarin?

A

Restart warfarin when INR <5

34
Q

How often should INR be monitored?

A

INR should be monitored every 1-2 days in early treatment, and then every 12 weeks

35
Q

Warfarin - side effects

A

MHRA Warning: SKIN NECROSIS AND CALCIPHYLAXIS
- Painful skin rash
Haemorrhage: Prolonged Bleeding
- Vitamin K1 (phytomenadione) antidote

36
Q

Warfarin - CI

A

Pregnancy: Avoid in the first and third trimester
Use contraception

37
Q

Warfarin - interactions

A

Vitamin K Rich Foods
Pomegranate and Cranberry Juice
Miconazole (OTC Daktarin oral gel)
CYP450 Enzyme Inhibitors and Inducers

38
Q

warfarin interactions - Vitamin k rich foods

A

Avoid major changed in diet with leafy greens
Reduces efficacy of warfarin

39
Q

warfarin interactions - Pomegranate and Cranberry Juice

A

Increases patient INR

40
Q

Miconazole (OTC Daktarin oral gel)

A

Increases patient INR

41
Q

CYP450 Enzyme Inhibitors and Inducers

A

Increases or decreases warfarin concentration respectively

42
Q

Warfarin - Minor procedures with low risk of bleeding

A

Performed with an (INR) of less than 2.5
Restart warfarin within 24 hours of procedure

43
Q

Warfarin - procedures where there is a risk of severe bleeding:

A

Stop warfarin 3-5 days before
Give Vitamin K if INR is 21.5 the day before surgery
Patients high risk of thromboembolism: bridge with LMWH → stop LMWH 24 hours before surgery → restart LMWH 48 hours after

44
Q

Warfarin - emergency Surgery

A

If can be delayed by 6-12 hours: IV Vitamin K
If can’t be delayed by 6-12 hours: IV Vitamin K + dried prothrombin complex

45
Q
A

PR - CARDIOVASCULAR SYSTEM (48 decks)

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