Venous Thromboembolism Flashcards
Virchow’s Triad
Hypercoagulable State
Vascular Injury
Circulatory Stasis
Types of venous clots/VTEs
Pulmonary embolism
Deep vein thrombosis
Risk factors causing a hypercoagulable state
Malignancy
Pregnancy
Inflammatory state
Factor V Leiden
Protein C/S deficiency
Oral contraceptives
Risk factors causing circulatory stasis
Hospitalization
Surgery
Obesity
Long distance travel
Risk factors causing vascular injury
Orthopedic surgery
Trauma
Venous catheters
Smoking
Risk factors contributing to multiple components of Virchow’s Triad
Age
History of VTE
Scoring tool used in hospitalized patients to determine need for VTE prophylaxis
PADUA Score
PADUA score that indicated thromboprophylaxis intitiation
/> 4
Heparin for VTE prophylaxis dose (BMI < 40 kg/m^2)
5,000 units q8-12h SQ
Heparin for VTE prophylaxis dose (BMI /> 40 kg/m^2)
7,500 units q8-12h SW
Enoxaparin for VTE prophylaxis dose
30 units BID or 40 units QD SQ
Anticoagulants that can be used in high-risk outpatients with cancer (Khorana score /> 2)
apixaban
rivaroxaban
LMWH
Anticoagulants that can be used for thromboprophylaxis in low-risk patients with multiple myeloma receiving thalidomide- or lenalidomide- based regimens with chemotherapy
aspirin or LMWH
Anticoagulants that can be used for thromboprophylaxis in higher-risk patients with multiple myeloma receiving thalidomide- or lenalidomide- based regimens with chemotherapy
LMWH
DVT signs and symptoms
Unilateral leg pain and/or swelling and warmth
Positive Homan’s Sign
Elevated D-dimer
VTE with no cancer treatment options (4)
dabigatran, rivaroxaban, apixaban, edoxaban
(over warfarin)
VTE and no cancer not treated with first line options (dabigatran, rivaroxaban, apixaban, edoxaban) treatment choice (1)
warfarin (over LMWH)
Prophylaxis agent indicated when patients with an unprovoked proximal DVT or PE are stopping anticoagulant therapy
aspirin
Anticoagulant treatment duration for proximal DVT or PE
3 months
Anticoagulant treatment duration for unprovoked VTE and low-moderate bleeding risk
extended therapy (no scheduled stop date)
Anticoagulant treatment duration for unprovoked VTE and high bleeding risk
3 months
Treatment for acute isolated distal DVT
serial imagining of the deep veins for 2 weeks (unless severe symptoms or risk factors)
Anticoagulant options for acute distal DVT
dabigatran, rivaroxaban, apixaban, edoxaban
When is anticoagulation indicated in patients with acute isolated distal DVT managed with serial imaging
if the thrombus extends
Initial anticoagulant therapy options in patients with cancer being treated for a DVT
LMWH, UFH, fondaparinux, rivaroxaban, apixaban
Long-term anticoagulant therapy options in patients with cancer being treated for a DVT
LMWH, edoxaban, rivaroxaban
Duration of anticoagulant therapy in patients with cancer being treated for DVT
at least 6 months
Low risk PE definition
Not meeting other criteria
Signs and symptoms of a pulmonary embolism (PE)
Couch, chest pain/tightness, SOB
Dyspnea, tachycardia, tachypnea
Elevated D-dimer
Massive PE definition
Systolic BP < 90 mmHg or decrease of 40 mmHg from baseline,
Requiring vasopressors,
Pulseless
Submassive PE definition
Right ventricular strain: on ECHO, (+) troponin, (+) BNP
Low risk PE treatment strategy (1)
therapeutic anticoagulation
Submassive PE treatment strategies (3)
Anticoagulation, thrombectomy, or catheter-directed thrombolytics
then anticoagulation
Massive PE treatment strategy
IV thrombolytics then therapeutic anticoagulation
Thrombolytic agents (3)
Alteplase
Reteplase
Tenecteplace
Mechanism of action of thrombolytics
activate plasminogen -> plasmin and degrade fibrin clots
Medications that can be used in catheter directed thrombolytics (CDT) (2)
heparin
alteplase
Anticoagulants preferred in PE treatment in patients with no cancer (4)
dabigatran
rivaroxaban
apixaban
edoxaban
Second line option for PE treatment in patients with no cancer (1)
warfarin
Duration of anticoagulant treatment in patients with a PE
3 months
Duration of anticoagulation therapy in patients with active cancer and PE
extended therapy (no scheduled stop date)