Venous Thromboembolic Disease Flashcards
high risk population for VTE includes:
critical illness, cancer, stroke, pregnancy
heart failure, MI
> 75 years old
previous VTE, prolonged immobility, inheritied hypercoagulable states
renal failure
prevention for non-high risk patients
early & often ambulation
+/- mechanical prophylaxis (SCDs)
pharmacotherapy not needed
prevention for high-risk patients
pharmacotherapy indicated (LMWH or UFH)
no need to continue administration beyond acute care stay
what do we need to watch out for with heparin?
what should throw up warning flags?
watch for Heparin Induced Thrombocytopenia (HIT)
50% in platelets shoudl thro up warning flag
clinical presentation of DVT
lower extremity swelling, pain, discoloration
exam findings for DVT
palpable cord
+ Homan’s sign
edema/discoloration
what is the common practice/management for DVT?
admit to hospital
confirm with ultrasound
anticoagulation (must continue for a minimum of 5 days)
what is our INR goal with anticoagulation?
2.0 - 3.0
what are our direct oral anticoagulants (novel agents)?
are they considered acceptable for monotherapy?
Rivaroxaban & Apixaban
yes, acceptable for monotherapy
symptoms for a submissive PE
dyspnea & tachypnea at rest or with exertion
pleuritic pain, cough, orthopnea
calf/thigh pain or swelling (DVT symptoms)
wheezing & coarse breath sounds
hemoptysis (13%)
symptoms for a massive PE?
all of the symptoms of a submissive PE PLUS
hypotension SBP < 90 mmHg
RV dilatation & dysfunction is also a bad sign & should throw up red flags
what diagnostic tool is used to confirm a PE?
CT pulmonary angiography
a systolic BP below what is very bad?
< 90
when should we get the hyper-coagulation panel for a PE patient?
AFTER the intial tx period is over 3 months & anticoagulation has been stopped
what are the indications for IVC filter?
can’t use pharmacologic anticoagulation (bleeding risk)
developed complication/recurrence on pharm therapy alone
retrievable filter design preferred
