venous thromboembolism Flashcards
What is a pulmonary embolism
where a blood clot forms in the pulmonary arteries
What are PE usually a result of
usually as a result of deep vein thrombosis
That developed in the legs and travelled through the venous system and the right side of the heart to the pulmonary system
risk factors for PE
Immobility
Recent surgery
Long haul flights
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia
Presentation of pulmonary embolism
- Shortness of breath
- Cough with or without blood (haemoptysis)
- Pleuritic chest pain
- Hypoxia
- Tachycardia
- Raised respiratory rate
- Low grade fever
- Haemodynamic instability causing hypotension
What may indicate DVT
unilateral leg swelling
tenderness
What is wells score used for
- predicts the risk of a patient presenting with symptoms actually having a DVT or PE
HOW TO DIAGNOSE PE
- history
- examination
- chestx ray
- wells score
what would you proceed to do after WELLS SCORE
- if likely PE then perform a CT pulmonary angiogram
- unlikely - perform a d - dimer and if positive perform a Computed tomography pulmonary angiography (CTPA)
Initial management of PE
- apixaban or rivaroxaban
- low molecular weight heparin if the above is not suitable
supportive management of PE
- Admission to hospital
- Oxygen as required
- Analgesia if required
- Adequate monitoring for any deterioration
thrombosis on the arterial side is driven by…
platelets
thrombosis on the arterial side should be treated with …
anti platelets
aspirin
what is thrombosis
blood coagulation inside a vessel
why would you use fondpaprinux over heparin
lower risk of bleeding as heparin has a short half life
and lower risk of haemorrhage
biggest risk factor for arterial thrombosis
atherosclerosis
main driving factor in venous thromboembolism
fibrin
three components of Virchow’s triad
endothelial damage
blood flow
change in coagulability
why dont u get atherosclerosis on the venous side
there is little to no smooth muscle cells on the venous side
when would the treatment of DVT be more aggressive
when there is a chance of the venous thrombosis becoming a pulmonary embolism
prevention for venous thrombosis
- Mechanical or chemical thromboprophylaxsis
- Also early mobilisation and good hydration
- compression stockings
most important anti coagulant
unfractioned heparin
features of heparin
- Glycosaminoglycan
- Binds to antithrombin and increases its activity
- Indirect thrombin inhibitor
to measure heparin activity
pro thrombin levels
What is HIT
heparin induced thrombocytopenia
