Thrombolytics Flashcards
True/False: Neonates are the most commonly affected age group of Thrombosis.
True: incidence 41:100k/yr
What is the initial presentation of thrombosis?
-Catheter does not work (cannot infuse or draw through line)
What is a less common thromboembolic phenomenon?
Caused by?
Inherited and acquired thrombophilia
Heterozygous factor 5, Protein C or S deficiency
CMV is a rare cause of Aortic thrombosis
What is thrombus?
A clot in an Artery or Vein causing complete or partial obstruction
What is an Embolus?
What can it cause?
A mobile clot that lodges in a blood vessel.
May cause obstruction or vasospasm.
What is a vasopsasm?
What is the sign of vasospasm?
Muscular contraction of Arterial vessel
Color change (blue or white) in the affected extremitiy
What may be a predisposing factor of vasospasm?
Blood sampling
Where may the color change of vasospasm extend to?
Is it transient or persistent?
Is it caused by prior injection of a med or manifestation of Thromboembolism or Thromobembolytic phenomenon (inherited D/O)??
Buttocks or badomen
Both/either
Either
Venous thrombosis is caused by?
Renal vein thrombosis or indwelling venous catheters
What are the sign of venous thrombosis?
- Extremities swollen
- Extremities discolored
- Distended superficial veins
What are the signs of Renal vein thrombosis?
-Hematuria, hypertension, thrombocytopenia, flank mass
If pulses are completely absent, consider Venous or Arterial thrombosis?
Arterial (pulses duh!)
What are the signs of Arterial thrombosis? (6 things)
- Decreased perfusion and color change of lower extremities
- Loss of pulses
- B/P differences between upper and lower extremities
- Oliguria
- Hypertension
- Hematuria
An aortic thrombosis w/Absent Arterial pulse is what?
How common is this in NB’s?
A Medical Emergency
Rare-fortunately :-)
What labs are needed for a suspected thrombosis?
- TT
- PTT
- PT/INR
- PCV
- Plt count
- Fibrinogen
- Genetic tests/CMV work up
What diagnostic studies would you order for suspected thrombosis?
Which is most common?
Which is gold standard? Performed how?
U/S
Angiography
U/S is most common
Angiography is Gold Standard–through UAC (most effective technique)
Is a lab/diagnostic work up needed for a vasospasm?
When is a lab/diagnostic work up done?
No
Done if thrombus expected and dissolving meds are used.
True/False: Some studies show U/S underestimates the number of venous and arterial thrombosis and has significant false positive results.
True–it can be unreliable
When can U/S be used more reliably with a thrombus?
Monitoring progress over time
What are the general guidelines when a pt has a thrombus? (5 things)
- Prompt removal of catheter (take access into account and replace PRN)
- Tx: volume depletion, electrolyte abnormalities, spesis, thrombocytopenia, anemia
- Evaluate for IVH
- Did they have major surgery in past 10 days? Check for evidence of major bldg.
- Warfarin is NOT recommended. Use anti-coagulant or Thromboembolytic)
What are the General guidelines of thrombolytic agents?
- Tx is controversial-no preterm studies
- Maintain Plt count >50k & Fibrinogen >100mg/dL (may require plt tsfn or cyro)
- Monitor coags labs (PT/PTT/Fibrinogen)
- Can give meds through the catheter
What if you are treating w/thrombolytic agents and the catheter is obstructed?
Remove it and give systemic therapy
What does rtPA stand for?
Recombinant Tissue Plasminogen Activator
What does rtPA do?
Enhances the conversion of plasminogen to plasmin–>cleaves fibrin,fibrinogen, factor 5, and factor 8–>clot dissolution.
What is the name of the drug of choice for thrombolytic agent?
Why?
Alteplase
Lowst risk allergies, shortest T2, less manufacturing concerns
How is Alteplase given?
- Dilute dose in NS to volume needed to fill catheter
- Instill into lumen slowly and carefully–do not instill into systemic circulation (if this is not your intention)
- Dwell time of med in catheter = 2-4 hours
There is increased risk of bleeding when using what 2 other medications?
Indomethacin
Heparin
True/False: recently TPA has been used as continuous infusion for lysis of intercardiac or large vessel thrombus?
True
True/False: you might see low-dose Heparin sued to prevent recurrence of the thrombus?
True
What are the adverse effects of TPA?
IVH Allergic rxn (very rarely)
True/False: Streptokinase and Urokinase are no longer being used (replaced by rTPA)
True
When is systemic use of TPA not recommended?
Pre-existing IVH or cerebral ischemic changes
With TPA use would you correct HTN before or after TPA use?
Before
Can severe bleeding complications occur?
Yes
If you have an occluded CVC, bleeding may occur with what?
Excessive use of TPA reaching systemic circulation
What might happen with excessive force of TPA administration?
Thromboembolism (forced clot into systemic circulation)
