Thromboembolism- Thromboprophylaxis in pregnancy Flashcards
which drug is prescribed prophylactically to all pregnant women at risk of developing a VTE during hospital admission?
low molecular weight heparin
how long should pharmacological prophylaxis be continued for in pregnant women?
Continued until there is no longer a risk of venous thromboembolism, or until discharge from hospital
In women who have given birth, had a miscarriage or termination of pregnancy during the past 6 weeks, what drug should be prescribed for thromboprophylaxis, how soon should it be prescribed and how long should should it be continued for?
LMWH: 4–8 hours after the event, unless contra-indicated, and continue for a minimum of 7 days.
Additional mechanical prophylaxis can be given to women who have significant reduced mobility. What mechanical options would be suitable?
Intermittent pneumatic compression should be used as the first-line option and anti-embolism stockings as an alternative
Edoxaban, an inhibitor of factor Xa, what conditions is it indicated for?
1) Treatment and prophylaxis of VTE
2) Prophylaxis of stroke and systemic embolism in non-valvular AF, in patients with at least one risk factor
how long should edoxaban be given for?
shorter duration of treatment (at least 3 months) should be based on transient risk factors i.e. recent surgery, trauma, and longer durations should be based on permanent risk factors or idiopathic deep-vein thrombosis or pulmonary embolism
What drugs should be used in the the initial treatment of deep-vein thrombosis and pulmonary embolism?
1) LMWH
↳Alternatively, heparin (unfractionated) is given as an IV loading dose, followed by continuous IV infusion or intermittent subcutaneous injection.
2) An oral anticoagulant (warfarin) is started at the same time
Warfarin is started at the same time as unfractionated or LMWH in the treatment of DVT. How long should the heparin be continued for while on warfarin?
The heparin needs to be continued for at least 5 days and until the INR is ≥2 for at least 24 hours
Laboratory monitoring for heparin (unfractionated), preferably on a daily basis, is essential. what is the most widely used measure?
Activated partial thromboplastin time (APTT)
1) Why are heparins used in the management of VTE in pregnancy ?
2) In particular, explain why LMWH are preferred?
1) Heparins do not cross the placenta.
2) LMWH have a lower risk of osteoporosis and of heparin-induced thrombocytopenia
why are the dosage regimens of LMWH ( e.g. Dalteparin, enoxaparin, tinzaparin) altered in pregnancy?
LMWH are eliminated more rapidly in pregnancy
when should the treatment of VTE in pregnancy be stopped?
At the onset of labour and advice sought from a specialist on continuing therapy after birth
which drug is used in the maintenance of extracorporeal circuits in cardiopulmonary bypass and haemodialysis?
Heparin (unfractionated)
If rapid reversal of the effects of the heparin is required e.g. due to hemorrhage which drug can be administered?
Protamine sulfate is a specific antidote (but only partially reverses the effects of low molecular weight heparins)
Patients with, or at risk of venous thromboemoblism may be eligible for which pharmacy services?
NMS or MUR
