Thromboembolism

Question 1

Two types of thromboembolism

Answer 1

DVT + PE

Question 2

Risk factors associated with VTE

Answer 2

Obesity, immobility, malignacy, >60 years, hisotry of VTE, Drugs (COC)

Question 3

Examples of mechanical VTE

Answer 3

TEDS / IPC - used to produce a calf pressure of 14 - 15mmHg

Question 4

What conditions is mechanical VTE prophylaxis contraindicated in?

Answer 4

PAD, peripheral neuropathy, severe leg oedema, local conditions (cellulitis)

Question 5

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

Answer 5

14 hours of admission

Question 6

How long should mechanical prophylaxis be continued for?

Answer 6

Until patient is mobile / discharge or or 30 days post spinal or cranial surgery

Question 7

When should pharmacological VTE be considered?

Answer 7

If patient is high risk e.g. general or orthopedic surgery

Question 8

First line for pharmacological VTE

Answer 8

LMWH

Question 9

What VTE medication is an option for patients undergoin bariatric, thoracic, abdominal or cardiac surgery?

Answer 9

Fondaparinux

Question 10

For how long after general surgery should LMWH be continued for?

Answer 10

7 days post surgery or until mobility fully re-established

Question 11

How long should VTE prophylaxis be extended for following major cancer surgery in the abdomen

Answer 11

28 days

Question 12

How long should VTE prophylaxis be extended for following spinal surgery

Answer 12

30 days

Question 13

If a patient has elective hip replacement surgery what the VTE protocol?

Answer 13

1. LMWH for 10 days +Aspirin for further 28 days
   or 2. LMWH 28 days + AE stockings
   or 3. Rivaroxaban

Question 14

What is the pharmacological VTE propylaxis protocol for elective knee replacement?

Answer 14

Low dose aspirin for 14 days

or LMWH 14 days + TEDS until d/c or Rivaroxaban

Question 15

For acutely ill patients at risk of VTE, pharmacological prophylaxis should be offered for how long?

Answer 15

7 days minimum

Question 16

If a patient is admitted with a stroke what VTE prophylaxis should be used?

Answer 16

mechanical prophylaxis with IPCS (start within 3 days and continue for 30 days)

Question 17

What type of mechanical propylaxis is contraindicated in stroke patients?

Answer 17

Anti embolism stockings

Question 18

How soon after giving birth / miscarrying/terminating pregnancy should thromboprophylaxis with LMWH be started?

Answer 18

Within 4 to 8 hours after the event for a minimum of 7 days

Question 19

What are the treatment options for VTE?

Answer 19

LMWH, UFH or DOAC

Question 20

What parameter needs to be monitored with heparin?

Answer 20

APTT daily

Question 21

If a patient is to be treated with Warfarin for a DVT, how is it initiated?

Answer 21

Need to bridge wiht LMWH for 5 days or until INR is > 2for at least 24 hours

Question 22

Two reasons why LMWH preferred over UFH

Answer 22

1. osteoporosis risk is lower 2. Less of a risk of HIT

Question 23

Why is the dosage regime of LMWH in pregnancy different than normal prophylaxis?

Answer 23

LMWH is eliminated faster in pregancy so may need BD dosing

Question 24

What is the reversalagent for heparin?

Answer 24

Protamine (only partially reverses LMWH)