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Phar 505 > Treatment and Prophylaxis of VTE > Flashcards

Treatment and Prophylaxis of VTE Flashcards

1
Q

For initial VTE treatment what should patients be given

A

Rapid-acting anticoagulant

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2
Q

During warfarin initiation what should be overlapped with it, for how long, what parameters should be met

A

Injectable anticoagulants, 5 days and until the patient’s INR is greater than or equal to 2 for at least 24 hours

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3
Q

T/F: As long at the VTE and PE is uncomplicated patients can be treated outpatient

A

True

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4
Q

How long should VTE treatment be, when would it be longer

A

3 months, VTE reccurence and major bleeding

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5
Q

What are the deep veins in the body

A

Inferior vena cava, Iliac vein, Femoral vein, popliteal vein, anterior tibial vein

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6
Q

What are upper extremity DVT

A

thrombosis of the brachial, axillary, subclavian, and internal jugular veins

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7
Q

What usually cause the upper extremeity DVTs

A

Central venous catheter, Implantable cardiac defibrallator, cardiac pacemakers or other foreign implants

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8
Q

What are the three categories that can cause DVTs

A

Blood stasis, vascular injury, hypercoaguability

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9
Q

What are early methods of prophylaxis for VTE

A

Active or passive mobilization, Adequate hydration

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10
Q

What are two types of mechanical prophylaxis of VTEs

A

Graduated compression stockings, Intermittent pneumatic compression devices

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11
Q

Where is the most pressure in graduated compression stockings

A

At the ankles, decreases going up

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12
Q

How long should intermittent pneumatic compression devices be attached

A

At least 18 hours

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13
Q

What are the pharmacological choices for VTE prophylaxis is brought for medical illness

A

Heparin, LMWH, Fondaparinux, Betrixban

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14
Q

What is an appropriate Heparin dose for VTE prophylaxis, LMWH, Fondaparinux

A

5000 units SC every 8-12 hours, Enoxaparin 40 mg SC daily or 30 mg SC every 12 hours, Dalepartin 2500-5000 units SC daily, 2.5 mg SC daily

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15
Q

Which VTE prophylaxis pharmacologic agent can be taken by mouth, what is the correct dose

A

Betrixiban 160 mg once then 80 mg daily

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16
Q

According to the Padua Prediction Score what has the highest risk factor (3)

A

Active cancer, Previous VTE (with exclusion to superficial vein thrombosis), Reduced mobility, already known thrombillic conditions

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17
Q

What score on the Padua constitutes a high risk for VTE, low risk

A

4 or more, 3 or less

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18
Q

What do the 2018 ASH guidelines recommend for VTE prophylaxis

A

LMWH over DOACs for acute medically ill patients

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19
Q

T/F: For VTE prophylaxis LMWH should be used alone in inpatient prophylaxis without continuing therapy after discharge

A

True

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20
Q

For Critically ill patients what should be given for VTE prophylaxis

A

Heparin or LMWH

21
Q

For acutely and critically ill patients what is the hirearchy and options for VTE prophylaxis

A

Patients should receive pharmacological prophylaxis over mechanical prophylaxis, patients should receive only one type of prophylaxis at a time, pneumatic compression devices or compression stockings are the only to recommended mechanical prophylaxis

22
Q

What is the VTE prophylaxis recommendation for flying longer than 4 hours and no risk factors present

A

Nothing

23
Q

What is the VTE prophylaxis recommendation for flying longer than 4 hours with risk factors

A

Graduated compression stockings or prophylactic LMWH

24
Q

What is the VTE prophylaxis recommendation for flying longer than 4 hours with risk factors and the patient cannot recieve a graduated compression stocking or prophylactic LMWH

A

Aspirin

25
Q

What can be used to estimate VTE risk after general surgery, what are the categories

A

Caprini Score/ very low (0 to 1), low (2), moderate (3 to 4), high (greater than or equal to 5)

26
Q

What are known risk factors for surgical bleeding

A

Previous major bleeding, severe renal failure, concomitant antiplatelet agent, extensive surgical dissection and revision surgery

27
Q

T/F: Spinal/epidural hematomas may occur in patients on anticoagulation that are receiving neuraxial anastethia or undergoing spinal puncture

A

True

28
Q

When are the risks for bleeding highest after orthapedic surgery

A

First 7 to 14 day, after 35 days

29
Q

What is the VTE prophylaxis for hip or knee replacement

A

Minimum of 10-14 days LMWH is preferred (can use fondaparinox, DOACs except Betrixiban, Heparin, wafarin and aspirin)

30
Q

What is the VTE prophylaxis for hip fracture surgery

A

Minimum of 10-14 days LMWH is preferred ( can use fondaparinox, DOACs except Betrixiban, Heparin, warfarin and aspirin)

31
Q

What is the VTE prophylaxis if a patient is having major orthopedic surgery, how long

A

Dual prophylaxis with antithrombotics and IPC during hospital, possibly up to 35 days

32
Q

T/F: For Total Hip Arthroplasty, Total Knee Arthroplasty, and Hip Fracture Surgery the VTE prophylaxis dose for the injectables is mostly the same

A

True

33
Q

What are the lower ranges when using INR for VTE prophylaxis regarding orthopedic surgery

A

1.8-2.2

34
Q

What is the only type of surgery that Dabigatran is recommended for use in, what dose

A

110 mg once then 220 mg daily

35
Q

What is the only of surgery that Apixaban and Rivaroxaban are not indicated for

A

Hip Fracture Surgery

36
Q

If a patient is receiving LMWH as thrombophylaxis when should they get it

A

12 hour or more before the operation or 12 hours or more after the operation

37
Q

What is the order for using injectable anticoagulants for surgery prophylaxis, what is the best option if the kidney function is bad

A

LMWH, Fondaparinox, Heparin/ Heparin

38
Q

What is a permenant solution for not getting a blood clot in the lungs, how long should they be in the vessel

A

IVC filters, 6 months

39
Q

What are symptoms of DVT, what labratory test help determine

A

Leg swelling, pain, or warmth, elevated D-dimer

40
Q

If a patient comes in with VTE and has severe cadiopulmonary compromise or high risk of limb loss what should be given

A

Heparin or LMWH

41
Q

If a patient come in with VTE and has active bleeding or a contraindication to an anticoagulant

A

Place IVC filter, initiate anticoagulation when bleeding or contraindication resolves

42
Q

What are the outpatient VTE treatments

A

Rivaroxaban 15mg BID for 21 days THEN 20 mg daily, Apixiban 10 mg BID for 7 days THEN 5 mg BID for up to 90 days THEN 2.5 mg BID, LMWH/fondaparinux for 5 days then SWITCH to dabigatran or edoxaban, LMWH/fondaparinux OVERLAPPED with warfarin for at least 5 days AND the INR is greater than 2 then dose adjust to 2-3 range

43
Q

What is the dosing of enoxaparin for TREATMENTof VTE

A

1 mg/kg SC every 12 hours OR 1.5mg/kg SC every 24 hours

44
Q

T/F: ACCP guidelines suggest Warfarin over DOACs

A

False: DOACs (dabigatran, rivaroxaban, apixaban or edoxaban) is suggested over warfarin

45
Q

How long should clots be treated

A

3 months

46
Q

What are consequences of postthrombotic syndrome

A

Hyperpigmentation, venous ulcer, venous ectasia, edema

47
Q

When is warfarin stopped for someone going into surgery why, what may be given instead but what is the cavieat

A

5 days, lower INR to 1.5, LMWH but the last dose must be 24-36 hours prior to the procedure

48
Q

How long should DOACs be held before a major surgery

A

A minimum of 1 day for low risk, 2-3 days for high risk

49
Q

When is it okay to switch Warfarin to Rivaroxaban, Apixaban

A

INR should be less than 3, INR less than 2

Phar 505 (33 decks)

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