venous thromboembolism

Question 1

virchow’s triad for why blood clots when it shouldn’t

Answer 1

1. activation of coag
2. venous stasis
3. injury to vessel wall

Question 2

2 main types of VTEs

Answer 2

1. PE
2. DVT
   - same disease, different course

Question 3

most common location of DVT

Answer 3

legs»»arms

Question 4

3 classes of DVT

Answer 4

1. proximal - pop>iliac>IVC - 90% of PEs
2. distal/calf - below knee - rarely PE
3. superficial - not a DVT, never PE

Question 5

what is key component leading to PE

Answer 5

proximal DVT

Question 6

what is epi of VTE

Answer 6

• age dep.

- most common preventable cause of death in hosp.

Question 7

**9 acute risk factors for VTE

Answer 7

1. major surg.
2. trauma
3. CA
4. CA treatments
5. immobilization
6. acute medical illness
7. acute infection
8. inflammation
9. E, preg, post-partum

Question 8

5 other risk factors for VTE

Answer 8

1. previous VTE
2. fam Hx
3. inherited
4. age
5. obesity

Question 9

where are most VTE aquired

Answer 9

hospital

Question 10

3 major risk surgeries

Answer 10

1. spinal cord
2. trauma
3. ortho

Question 11

how long is VTE risk for

Answer 11

up to 12 weeks out of hospital

Question 12

what is role of immobilozation

Answer 12

alone not a factor, but in combination with other factors

Question 13

what is relation to CA

Answer 13

25x in CA

- often first manifestation of CA

Question 14

3 E related risks for VTE

Answer 14

1. OCP - 4x
2. HRT - 4X
3. preg

Question 15

why does a VTE develop

Answer 15

generally multifactorial with a number of factors

Question 16

S and Sx of DVT (4)

Answer 16

1. leg swelling
2. leg pain
3. warmth
4. purple-blue colot
   many have no Sx

Question 17

S and Sx of PE

Answer 17

1. SOB
2. chest pain
3. desaturation
4. tachycard
5. unexplained fever
6. blood in sputum
7. feeling faint

Question 18

investigations for VTE

Answer 18

D-dimer - not a very good test
DVT - doppler US
PE - CXR

Question 19

what is d-dimer

Answer 19

formed by plasmin effect on fibrin

- increased in VTE

Question 20

what is seen on doppler

Answer 20

can’t collapse the vein

Question 21

3 tests for PE

Answer 21

1. CT pulm angio
2. look for DVTs
3. V/Q scan - rules out PE if perfusion normal

Question 22

4 possible treatments

Answer 22

1. IV heparin
2. LMWH
3. oral warfarin
4. directo oral anticoags

Question 23

MOA, adv. and dis of IV hep

Answer 23

MOA:
- inhibs factors 2, 10, 9, 11, 12
adv:
- good control of coag cascade
- rapidly reversed
dis:
- IV  -in patient
- frequent PTT tests
- possible HIT

Question 24

MOA, adv. and dis of LMWH

Answer 24

MOA:
- inhibs factor 10 and 2
adv:
- sub-cut
- predictable
- can vary dose
dis:
- needle phobia
- renal accum
- costly

Question 25

MOA, adv. and dis of IV warfarin

Answer 25

MOA:
- inhib vit K factors: 10, 9, 7, 2
adv:
- 60 years
- not renal
- labmonitoring
- cheap
dis
- lab monitoriing
- unpredictable
- 50 fold varitation in dose

Question 26

MOA, adv. and dis of direct oral anti-coag

Answer 26

MOA
- 10a or 2a inhibs
adv
- fixed dose
- few interaction
- no labs
dis
- uncertain doses
- renal accum
- cost

Question 27

3 basic VTE treatment options

Answer 27

1. LMWH q1d for 5-7 days, + warfarin
2. LMWH q1d for fll time
3. direct oral anti-coag

Question 28

2 clot reduction therapies for massive PE

Answer 28

1. cath. endo therapy

2. tPA

Question 29

therapy for massive DVT

Answer 29

tPA

Question 30

how long for anti-coag

Answer 30

3 months + continue if at risk of recurrence (unprovoked, active factors)

Question 31

what is natural VTE history

Answer 31

slowly go away

Question 32

3 outcomes

Answer 32

1. recur in 30%
2. post-thrombotic syndrome - 20-50%
3. chronic pulm hypertension - 2-5%