Venous Thromboembolism Flashcards
DVT presentation?
(U) asymp
swelling, pain, warm, red
Palpable cord and/or difference >3 cm b/w legs = bad
DVT physical exam components? (6)
Vascular Extremities Lungs Cardiac Abdominal Skin
DVT Wells Score?
probability of DVT: High = >=3 aggravators
CA, bedridden, swelling, etc: each get point
DVT labs? (5)
CBC w/ platelets Coag: PT/INR, aPTT Metabolic Panels: renal and liver UA D-dimer
High D-dimers (from fibrin clots) caused by what conditions?
DVT/PE
Post-op
Malignancy
Pregnancy
DVT diagnostic tests?
*Compression US = loss of vein compressibility
Contrast Venography
DVT testing algorithm
If high risk and US = abn -> positive DVT
If US = normal -> do venography
If veno = normal -> no DVT
If veno = abn -> + DVT
DVT tx
Prevent clot propagation and PE
UE DVT etiology?
spontaneous: thoracic outlet synd
2º: catheter, prothrombic states
UE DVT tx?
anticoag
thrombolysis
surgical decompression
DVT vs Superficial Thrombophlebitis (STP) cause?
DVT: Virchow’s Triad (stasis, vascular injury, hypercoag)
STP: venous cath/line, pregnancy, trauma, hypercoag
DVT vs Superficial Thrombophlebitis (STP) presentation?
DVT: swelling
STP: swelling uncommon
DVT vs Superficial Thrombophlebitis (STP) tx?
DVT: anticoag
STP: Ø anticoag, local heat, NSAIDS
PE definition?
pulmonary artery or branch obstruction from material originating elsewhere
PE (U) caused by?
DVT (U) proximal, rarely from calf DVT
Massive vs Submassive PE?
Massive: a/w SBP < 90 or ↓ >= 40 for > 15min;
NOT explained by hypovolemia, sepsis, MI, pneumothorax, new arrhythmia,
results in RV failure
Submassive: all others
PE sxs? (6)
dyspnea pleuritic pain calf/thigh pain/swelling cough orthopnea wheezing
PE signs?
tachypnea tachycardia rales ↓ breath sounds ↑ S2 JVD LE DVT sxs
PIOPED II says most common sign and sx of PE are?
dyspnea
tachypnea
PE prediction
Wells for DVT >4 = PE likely
PE physical eval?
Vital signs general exam (BP, HR, RR, mental status)
PE labs?
same as DVT
(P) thrombin, BNP
PE gold stand test?
pulmonary angiography:
highly specific/sensitive
disadv: invasive, contrast, expensive
VTE tx strategies? (5)
1) Anticoag
2) Thrombolytics
3) Thromectomy
4) IVC filter
5) Prophylactics
Anticoag meds? (6)
1) IV unfractionated Heparin
2) Low MW Heparin
3) Warfarin
4) Fondaparinux
5) Factor Xa Inhibitors
6) Direct Thrombin Inhibitors
IV Unfractionated Heparin:
indication
action
Initial tx of VTE
Inactivates thrombin, potentiates antithrombin
Low MW Heparin:
indication
action
outpt DVT and stable PE tx
Inhibits Factor Xa
Warfarin:
indication
action
long term VTE tx
blocks vit K-dependent coag proteins in liver
Duration of Anticoag for:
major transient risk?
minor transient risk?
3 months for either
Duration of Anticoag for:
cancer?
unprovoked thrombosis?
underlying thrombophilia?
CA = 3-6 mo or while CA active
unprovoked = 3 mo
thrombophilia = indefinite, test 3 mo post event
Thrombolytics:
indication
action
unstable PE
activates plasminogen to make plasmin ->
accelerates lysis of thrombi
IVC Filters are/do?
filter placed in IVC,
stops clot from moving to lungs
IVC Filter indication?
Contraindication?
recurrent PE despite anticoag
complications to anticoag
hemo or respiratory compromise
contraindicated w/ anticoag
Prophylactics for DVT in hospital?
TED hose,
Sequential compression
Heparin low-dose, Lovenox
Outpt tx of DVT if? (6)
ambulatory and stable normal vitals low bleeding risk no renal insuff LMWH/warfarin w/ monitoring bleed and VTE monitoring
