Venous Thromboembolism

Question 1

Virchow’s Triad

Answer 1

Hypercoagulable State
Vascular Injury
Circulatory Stasis

Question 2

Types of venous clots/VTEs

Answer 2

Pulmonary embolism
Deep vein thrombosis

Question 3

Risk factors causing a hypercoagulable state

Answer 3

Malignancy
Pregnancy
Inflammatory state
Factor V Leiden
Protein C/S deficiency
Oral contraceptives

Question 4

Risk factors causing circulatory stasis

Answer 4

Hospitalization
Surgery
Obesity
Long distance travel

Question 5

Risk factors causing vascular injury

Answer 5

Orthopedic surgery
Trauma
Venous catheters
Smoking

Question 6

Risk factors contributing to multiple components of Virchow’s Triad

Answer 6

Age
History of VTE

Question 7

Scoring tool used in hospitalized patients to determine need for VTE prophylaxis

Answer 7

PADUA Score

Question 8

PADUA score that indicated thromboprophylaxis intitiation

Answer 8

/> 4

Question 9

Heparin for VTE prophylaxis dose (BMI < 40 kg/m^2)

Answer 9

5,000 units q8-12h SQ

Question 10

Heparin for VTE prophylaxis dose (BMI /> 40 kg/m^2)

Answer 10

7,500 units q8-12h SW

Question 11

Enoxaparin for VTE prophylaxis dose

Answer 11

30 units BID or 40 units QD SQ

Question 12

Anticoagulants that can be used in high-risk outpatients with cancer (Khorana score /> 2)

Answer 12

apixaban
rivaroxaban
LMWH

Question 13

Anticoagulants that can be used for thromboprophylaxis in low-risk patients with multiple myeloma receiving thalidomide- or lenalidomide- based regimens with chemotherapy

Answer 13

aspirin or LMWH

Question 14

Anticoagulants that can be used for thromboprophylaxis in higher-risk patients with multiple myeloma receiving thalidomide- or lenalidomide- based regimens with chemotherapy

Answer 14

LMWH

Question 15

DVT signs and symptoms

Answer 15

Unilateral leg pain and/or swelling and warmth
Positive Homan’s Sign
Elevated D-dimer

Question 16

VTE with no cancer treatment options (4)

Answer 16

dabigatran, rivaroxaban, apixaban, edoxaban
(over warfarin)

Question 17

VTE and no cancer not treated with first line options (dabigatran, rivaroxaban, apixaban, edoxaban) treatment choice (1)

Answer 17

warfarin (over LMWH)

Question 18

Prophylaxis agent indicated when patients with an unprovoked proximal DVT or PE are stopping anticoagulant therapy

Answer 18

aspirin

Question 19

Anticoagulant treatment duration for proximal DVT or PE

Answer 19

3 months

Question 20

Anticoagulant treatment duration for unprovoked VTE and low-moderate bleeding risk

Answer 20

extended therapy (no scheduled stop date)

Question 21

Anticoagulant treatment duration for unprovoked VTE and high bleeding risk

Answer 21

3 months

Question 22

Treatment for acute isolated distal DVT

Answer 22

serial imagining of the deep veins for 2 weeks (unless severe symptoms or risk factors)

Question 23

Anticoagulant options for acute distal DVT

Answer 23

dabigatran, rivaroxaban, apixaban, edoxaban

Question 24

When is anticoagulation indicated in patients with acute isolated distal DVT managed with serial imaging

Answer 24

if the thrombus extends

Question 25

Initial anticoagulant therapy options in patients with cancer being treated for a DVT

Answer 25

LMWH, UFH, fondaparinux, rivaroxaban, apixaban

Question 26

Long-term anticoagulant therapy options in patients with cancer being treated for a DVT

Answer 26

LMWH, edoxaban, rivaroxaban

Question 27

Duration of anticoagulant therapy in patients with cancer being treated for DVT

Answer 27

at least 6 months

Question 28

Low risk PE definition

Answer 28

Not meeting other criteria

Question 28

Signs and symptoms of a pulmonary embolism (PE)

Answer 28

Couch, chest pain/tightness, SOB Dyspnea, tachycardia, tachypnea Elevated D-dimer

Question 29

Massive PE definition

Answer 29

Systolic BP < 90 mmHg or decrease of 40 mmHg from baseline, Requiring vasopressors, Pulseless

Question 29

Submassive PE definition

Answer 29

Right ventricular strain: on ECHO, (+) troponin, (+) BNP

Question 30

Low risk PE treatment strategy (1)

Answer 30

therapeutic anticoagulation

Question 31

Submassive PE treatment strategies (3)

Answer 31

Anticoagulation, thrombectomy, or catheter-directed thrombolytics then anticoagulation

Question 32

Massive PE treatment strategy

Answer 32

IV thrombolytics then therapeutic anticoagulation

Question 33

Thrombolytic agents (3)

Answer 33

Alteplase Reteplase Tenecteplace

Question 34

Mechanism of action of thrombolytics

Answer 34

activate plasminogen -> plasmin and degrade fibrin clots

Question 35

Medications that can be used in catheter directed thrombolytics (CDT) (2)

Answer 35

heparin alteplase

Question 36

Anticoagulants preferred in PE treatment in patients with no cancer (4)

Answer 36

dabigatran rivaroxaban apixaban edoxaban

Question 37

Second line option for PE treatment in patients with no cancer (1)

Answer 37

warfarin

Question 38

Duration of anticoagulant treatment in patients with a PE

Answer 38

3 months

Question 39

Duration of anticoagulation therapy in patients with active cancer and PE

Answer 39

extended therapy (no scheduled stop date)