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RESP (Respiratory Medicine) > Venous Thromboembolism (VTE) - General > Flashcards

Venous Thromboembolism (VTE) - General Flashcards

1
Q

Why can a VTE cause a stroke?

A

An ASD can allow a thrombus to bypass the pulmonary circulation and enter the systemic circulation.

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2
Q

Risk Factors of VTE (9).

A
  1. Immobility.
  2. Recent Surgery (60-90 Minutes+).
  3. Long-Haul Travel.
  4. Pregnancy.
  5. Hormone Therapy with Oestrogen (COCP + HRT).
  6. Malignancy.
  7. Polycythaemia.
  8. SLE.
  9. Thrombophilia.
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3
Q

Give 7 Thrombophilias.

A
  1. ANTIPHOSPHOLIPID SYNDROME (recurrent miscarriage).
  2. Factor V Leiden (commonest).
  3. Antithrombin III Deficiency.
  4. Protein C/S Deficiency.
  5. Hyperhomocysteinaemia.
  6. Prothrombin Gene Variant (2nd commonest)
  7. Activated Protein C Resistance.
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4
Q

Medication Risk Factors of VTE.

A
  1. COCP - especially 3rd Generation.
  2. HRT - especially bihormonal.
  3. Raloxifene + Tamoxifen.
  4. Antipsychotics.
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5
Q

VTE Prophylaxis.

A

Anyone at risk - prophylaxis with LMWH e.g. Enoxaparin or Fondaparinux Sodium (SC) and anti-embolic compression stockings.

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6
Q

Contraindications for LMWH (2).

A
  1. Active Bleeding.

2. Existing Coagulation with Warfarin or DOAC.

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7
Q

Contraindication for anti-embolic compression stocking.

A

Peripheral arterial disease.

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8
Q

Differential Diagnoses for D-Dimer Raise (6).

A
  1. VTE - DVT.
  2. Pneumonia.
  3. Malignancy.
  4. Surgery.
  5. Heart Failure.
  6. Pregnancy.
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9
Q

Initial Management of VTE.

A

Anticoagulation with DOACs e.g. Apixaban or Rivaroxaban (immediately if suspected).

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10
Q

Long-Term Medical Management of VTE (4).

A
  1. DOAC or Warfarin or LMWH.
  2. LMWH is 1st line in Pregnancy.
  3. Warfarin is 1st line in Antiphospholipid Syndrome (with initial concurrent treatment with LMWH) and target INR is between 2-3.
  4. Continue anticoagulation for 3 months (reversible cause), 3-6 months (active cancer), 3+ months (unclear cause, recurrent VTE, irreversible underlying cause e.g. thrombophilia).
  5. Use HAS-BLED Score to compare benefits vs. risk of bleeding.
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11
Q

Investigations of Unprovoked VTE (3).

A
  1. Review History, Baseline Bloods, Physical Exam for Cancer.
  2. Test for Antiphospholipid Syndrome (Antiphospholipid Antibodies).
  3. Test for Hereditary Thrombophilias (only 1st Degree Relative also affected by VTE).
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12
Q

Additional Management in VTE.

A
  1. Percutaneous Massive Thrombectomy (Massive DVT).

2. IVC Filter (Reduced Risk of PE, but contraindication : Anticoagulation).

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13
Q

What is Budd-Chiari Syndrome?

A

Thrombosis in the Hepatic vein, to cause acute hepatitis : triad of abdominal pain, hepatomegaly, ascites.

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14
Q

Management of Budd-Chiari Syndrome (2).

A
  1. Anticoagulation (Heparin, Warfarin).

2. Treatment of Underlying Cause of Hypercoagulable State and Treatment of Hepatitis.

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15
Q

Post-Procedure Prophylaxis VTE - Elective Hip (3).

A
  1. LMWH 10 Days + Aspirin for 28 Days.
  2. LMWH + Anti-Embolism Stockings for 28 Days.
  3. Rivaroxaban.
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16
Q

Post-Procedure Prophylaxis VTE - Elective Knee.

A
  1. Aspirin 14 Days.
  2. LMWH for 14 Days + Anti-Embolism Stockings.
  3. Rivaroxaban.
17
Q

Post-Procedure Prophylaxis VTE - Fragility Fracture.

A

1 Month if VTE Risk outweighs risk of bleeding with LMWH 6-12 hours after surgery or Fondaparinux Sodium 6 hours after surgery.

18
Q

Indications of LMWH and Fondaparinux (2).

A
  1. VTE - LMWH is 1st line prophylaxis and initial treatment.

2. ACS - 1st line therapy to improve revascularisation and prevent intracoronary thrombus progression.

19
Q

Mechanism of Action of LMWH and Fondaparinux (3).

A
  1. Unfractionated Heparin (UFH) activates Antithrombin - to inactivate clotting factor Xa and Thrombin.
  2. LMWH preferentially inhibit factor Xa.
  3. Fondaparinux inhibits factor Xa only.
20
Q

Cautions of LMWH and Fondaparinux (5).

A
  1. Clotting Disorders.
  2. Severe Uncontrolled Hypertension.
  3. Recent Surgery/Trauma.
  4. Invasive Procedures e.g. Lumbar Puncture and Spinal Anaesthesia.
  5. Renal Impairment (use lower dose or UFH).
21
Q

Adverse Effects of LMWH and Fondaparinux.

A
  1. Bleeding (slightly lower with Fondaparinux).
  2. Injection Site Reaction.
  3. Heparin-Induced Thrombocytopenia (more with UFH).

RESP (Respiratory Medicine) (35 decks)

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