Thromboprophylaxis

Question 1

Mechanical prophylaxis

Answer 1

• Early ambulation after surgery is cheap and is effective
• Compression stockings (contra -indicated in peripheral arterial disease)
• Intermittent pneumatic compression devices
• Foot impulse devices

Question 2

Low molecular weight heparin mechanism

Answer 2

Binds antithrombin resulting in inhibition of factor Xa

Question 3

LMWH use

Answer 3

In patients with normal renal function, low doses typically given in those with moderate to high risk of thromboembolic events. It is given as once daily subcutaneous injection

Question 4

Unfractionated heparin mechanism

Answer 4

Binds antithrombin III with affects thrombin and factor Xa

Question 5

Unfractionated heparin use

Answer 5

Effective anticoagulation, administered intravenously it has a rapid onset and its therapeutic effects decline quickly on stopping and infusion. Its activity is measured using the APTT. If need be it can be reversed using protamine sulphate

Question 6

Dabigatran mechanism

Answer 6

Orally administered direct thrombin inhibitor

Question 7

Dabigatran use

Answer 7

Used prophylaxis in hip and knee surgery. It does not require therapeutic monitoring. It has no known antidote and should not be used in any patient in whom there is a risk of active bleeding or imminent likelihood of surgery