Venous Thromboembolic Disease Flashcards
VTE encompasses both __ and ___ and means that there is a ___- within the venous circulation.
VTE encompasses both PE and DVT and means that there is a clot within the venous circulation.
what are venous clots composed of mainly? 2
red blood cells and fibrin
where do DVTs form
Thrombi form predominantly in the venous valve pockets and other sites of presumed stasis
what does a distal DVT refer to?
this refers to DVT of the calves
what does a proximal DVT refer to?
DVT of the popliteal vein or the femoral vein
PE alone ___% mortality at 3 months
17.5
Post thrombotic syndrome occurs in __% of proximal DVTs
30%
DVT alone __% mortality at 3 months
0.5
what are the three components of virchows triad?
- endothelial damage
- stasis
- hypercoagulable state
state some reasons for a hypercoagulable state? 6
- malignancy
- pregnancy and peripartum period
- oestrogen therapy
- Inflammatory bowel disease
- Sepsis
- Thrombophilia
what are some causes of stasis to blood flow?
- Left ventricular dysfunction
- Immobility or paralysis
- Venous insufficiency or varicose veins
- Venous obstruction from tumour, obesity or pregnancy
what are some reasons for endothelial damage?
- Venous disorders
- Venous valvular damage
- Trauma or surgery
- Indwelling catheters
give some examples of exposing risk factors, 6
- surgery
- Trauma
- Acute medical illness
- Acute heart failure
- Acute respiratory failure
- Central venous catheterisation
give some examples of predisposing risk factors, 11
- History of VTE
- chronic heart failure
- advanced age
- varicose veins
- obesity
- Immobility or paresis
- Myeloproliferative disorders
- pregnancy/peripartum period
- I-nherited or acquired thrombophilia
- hormone therapies
- renal insufficiency
give some examples of predisposing and exposing risk factors, 2
cancer
inflammatory disease
what is the biggest risk factor for VTE?
having had one before
what are the consequences of VTE? 5
- Fatal PE
- risk of recurrent VTE
- Post-thrombotic syndrome (PTS)
- Chronic thromboembolic pulmonary hypertension (CTEPH)
- Reduced quality of life
what is PTS?
DVT-induced damage to valves in the deep veins and valvular reflux leading to venous hypertension are thought to be associated with PTS.
what i PTS characterised by? 6
- pain
- oedema
- Hyperpigmentation
- eczema
- varicose collateral veins
- venous ulceration
When there is stasis in the leg you get ___- deficiency and skin changes.
iron
CTPH is a relatively rare, but serious, complication of ___.
CTPH is a relatively rare, but serious, complication of PE.
In CTPH, the original embolic material is replaced over time with _____ _____ that is incorporated into the ____ and _____ of the pulmonary arteries. This material may occlude the pulmonary artery, leading to pulmonary artery resistance and, ultimately, ________.
In CTPH, the original embolic material is replaced over time with fibrous tissue that is incorporated into the intima and media of the pulmonary arteries. This material may occlude the pulmonary artery, leading to pulmonary artery resistance and, ultimately, right heart failure.
what are the symptoms of CTPH
- initial phase often asymptomatic
- followed by progressive breathlessness and hypoxaemia
- pain
what are the signs of ctph
raised JVP, swollen legs
what is one surgical treatment option for ctph?
pulmonary enderectomy
what happens in pulmonary enderectomy?
the blood vessels of the lungs are cleared of clot and scar material
what are the pharmacolical interventions for VTE?
- anticoagulation
- thrombolysis
- analgesia
what are the mechanical interventions for VTE?
- graduated compression stockings
- IVC filters
what screening is undertaken in VTE?
cancer
thrombophilia
what treatment is given for provoked VTE? 2 stages
LMWH for at least 5 days or until INR >2
VKA within 24 hours continued for 3 months
what treatment is given for unprovoked VTE? 3 stages
LMWH for at least 5 days or until INR >2
VKA within 24 hours continued for 3 months
assess the risks and benefts of continuing anticoagulation for prevention of VTE recurrence
what treatment is given for VTE in patients with active cancer? 2 stages
LMWH for 6 months
reassess for continued treatment
what is the alternative to VKA?
NOACs
name 4 NOACs now recommended?
apixaban, rivaroxaban, dabigatran, edoxaban
what is the problem with VKAs?
e.g. warfarin - people need regular blood tests as it has a small therapeutic range
what is an advantage of the NOACs?
they don’t come with the over-anticoagulation risks as warfarin
what is an disadvantage of the NOACs?
They don’t have an antidote though but they have a short half life
LMWH: works on factor ___ like the NOAcs but it does it indirectly
10 a
_____ and ______ are used in PE now
Apexiban and rivaroxiban are used in PE now
what is the treatment for drug use associated VTE?
Rivaroxiban or fragmin
what is the treatment for cancer associated VTE?
fragmin
what is phlegmasia?
this is such extensive DVT that the arteries are compromised so you get ischaemia
