venous thromboembolism Flashcards

1
Q

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

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

2 main types of VTEs

A
  1. PE
  2. DVT
    - same disease, different course
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3
Q

most common location of DVT

A

legs»»arms

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4
Q

3 classes of DVT

A
  1. proximal - pop>iliac>IVC - 90% of PEs
  2. distal/calf - below knee - rarely PE
  3. superficial - not a DVT, never PE
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5
Q

what is key component leading to PE

A

proximal DVT

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6
Q

what is epi of VTE

A
  • age dep.

- most common preventable cause of death in hosp.

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7
Q

**9 acute risk factors for VTE

A
  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
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8
Q

5 other risk factors for VTE

A
  1. previous VTE
  2. fam Hx
  3. inherited
  4. age
  5. obesity
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9
Q

where are most VTE aquired

A

hospital

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10
Q

3 major risk surgeries

A
  1. spinal cord
  2. trauma
  3. ortho
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11
Q

how long is VTE risk for

A

up to 12 weeks out of hospital

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12
Q

what is role of immobilozation

A

alone not a factor, but in combination with other factors

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13
Q

what is relation to CA

A

25x in CA

- often first manifestation of CA

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14
Q

3 E related risks for VTE

A
  1. OCP - 4x
  2. HRT - 4X
  3. preg
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15
Q

why does a VTE develop

A

generally multifactorial with a number of factors

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16
Q

S and Sx of DVT (4)

A
  1. leg swelling
  2. leg pain
  3. warmth
  4. purple-blue colot
    many have no Sx
17
Q

S and Sx of PE

A
  1. SOB
  2. chest pain
  3. desaturation
  4. tachycard
  5. unexplained fever
  6. blood in sputum
  7. feeling faint
18
Q

investigations for VTE

A

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

19
Q

what is d-dimer

A

formed by plasmin effect on fibrin

- increased in VTE

20
Q

what is seen on doppler

A

can’t collapse the vein

21
Q

3 tests for PE

A
  1. CT pulm angio
  2. look for DVTs
  3. V/Q scan - rules out PE if perfusion normal
22
Q

4 possible treatments

A
  1. IV heparin
  2. LMWH
  3. oral warfarin
  4. directo oral anticoags
23
Q

MOA, adv. and dis of IV hep

A
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
24
Q

MOA, adv. and dis of LMWH

A
MOA:
- inhibs factor 10 and 2
adv:
- sub-cut
- predictable
- can vary dose
dis:
- needle phobia
- renal accum
- costly
25
MOA, adv. and dis of IV warfarin
``` 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 ```
26
MOA, adv. and dis of direct oral anti-coag
``` MOA - 10a or 2a inhibs adv - fixed dose - few interaction - no labs dis - uncertain doses - renal accum - cost ```
27
3 basic VTE treatment options
1. LMWH q1d for 5-7 days, + warfarin 2. LMWH q1d for fll time 3. direct oral anti-coag
28
2 clot reduction therapies for massive PE
1. cath. endo therapy | 2. tPA
29
therapy for massive DVT
tPA
30
how long for anti-coag
3 months + continue if at risk of recurrence (unprovoked, active factors)
31
what is natural VTE history
slowly go away
32
3 outcomes
1. recur in 30% 2. post-thrombotic syndrome - 20-50% 3. chronic pulm hypertension - 2-5%