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IPC CARDIOLOGY 2 JEN > Venous Thromboembolism (VTE) Prophylaxis > Flashcards

Venous Thromboembolism (VTE) Prophylaxis Flashcards

1
Q

What is VTE?

A

a clot occurring in the VENOUS circulation

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2
Q

Two types of VTE

A

Deep Vein Thrombosis (DVT)
Pulmonary Embolism (PE)

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3
Q

**FIRST SET OF CARDS HAS VICHOWS TRIAD, RISK FACTORS, DVT vs PE, THROMBUS, EMBOLISM but still pertains to this **

A

**FIRST SET OF CARDS HAS VICHOWS TRIAD, RISK FACTORS, DVT vs PE, THROMBUS, EMBOLISM but still pertains to this **

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4
Q

Platelet Cascade:

A

Platelet activation, platelet adhesion, platelet aggregation

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5
Q

Treat Platelet cascade (activation, adhesion, aggregation) with…

A

Antiplatelets

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6
Q

Arterial Clots include…

A

CAD, PAD, Strokes

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7
Q

The clotting cascade… treat with

A

anticoagulants

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8
Q

Venous clots include…

A

DVT, PE

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9
Q

VTE Prophylaxis treatment goal…

A

Prevent VTE from occuring in patients at high risk (usually hospitalized patients)

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10
Q

VTE Prophylaxis treatment

A

low dose anticoagulation, AND/OR mechanical prophylaxis

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11
Q

For VTE Hospitalized patients which score do we use?

A

PADUA score
MAGIC NUMBER 4

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12
Q

Padua score <4 …

A

low risk of VTE, generally does not require thromboprophylaxis

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13
Q

Padua score >4…

A

thromboprophylaxis is recommended for non-pregnant patients without contraindications (major bleeding, low platelets) who are over 18 years old

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14
Q

Which risk factors of Padua score are 3 points

A

Active cancer, previous VTE, reduced mobility, known genetic hypercoaguable condition

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15
Q

Which risk factors of Padua score are 2 points

A

recent trauma/surgery (within 1 month)

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16
Q

Which risk factors of Padua score are 1 point

A

> 70 years old, cardiac or respiratory failure, acute MI or ischemic stroke, acute infection or rheumatologic disorder, obesity (BMI > 30), hormonal treatment

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17
Q

Nonpharmacologic treatment options for VTE

A

Ambulation, Graduated Compression Stockings, Sequential Compression Devices (SCDs), Inferior vena cava filter

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18
Q

What is the Nonpharmacologic GOLD STANDARD treatment

A

Ambulation

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19
Q

Pharmacologic Treatment options HEPARIN DOSING VTE

A

5000 units Q8-12H
(much lower doses than the full therapeutic dosing)

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20
Q

Pharmacologic Treatment options LMWH DOSING VTE

A

30 units BID OR 40 units daily
(much lower doses than the full therapeutic dosing)

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21
Q

Malignancy treatment only applies to…

A

OUTPATIENTS

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22
Q

Malignancy treatment: Int-High Strong

A

Routine pharmacologic thromboprophylaxis SHOULD NOT be offered to all outpatients with cancer

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23
Q

Malignancy treatment: Int-High Moderate

A

High-risk outpatients with cancer (Khorana score >2) may be offered thromboprophylaxis with APIXABAN, RIVAROXABAN, LMWH, provided there are no significant risk factors for bleeding and no drug interactions

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24
Q

Malignancy treatment: Intermediate, Strong

A

Patients with MULTIPLE MYELOMA receiving THALIDOMIDE or LENALIDMIDE BASED REGIMENS with chemotherapy and/or dexamethasone should be offered pharmacologic thromboprophylaxis with either ASPIRIN or LMWH for lower risk patients and LMWH for higher risk patients

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25
Q

Khorana score: 2 points

A

Site of cancer: stomach, pancreas

26
Q

Khorana score: 1 point

A

-Site of cancer: lung, lymphoma, gynecologic, bladder, testicular, renal
-Prechemotherapy platelet count ≥ 350,000
-Hemoglobin < 10 g/dL or use red cell growth factors
-Prechemotherapy leukocyte count > 11,000
-BMI ≥ 35

27
Q

We care about distal vs proximal DVT because…

A

this may change whether we treat a patient or not

28
Q

Bleed Risk Assessment Risk factors

A

Will be given we just need to calculate score

29
Q

How to calculate Bleed Risk Assessment Risk factors

A

Low risk= 0 factors
Moderate risk= 1 Risk factor
High risk= >2 risk factors

30
Q

Distal DVT (below the knee)
In patients with acute isolated distal DVT in the leg…

A

we suggest SERIAL IMAGING OF THE DEEP VEINS FOR 2 WEEKS unless there are with severe symptoms or risk factors for extension, then we can suggest anticoagulation

31
Q

In patients managed with anticoagulation, we recommend…

A

using the same anticoagulation as for patients with acute proximal DVT

32
Q

In patients with acute isolated distal DVT of the leg who are managed with serial imaging we recommend…

A

NO ANTICOAGULATION IF THE THROMBUS DOES NOT EXTEND, SUGGEST ANTICOAGULATION IF THE THROMBUS EXTENDS

33
Q

In patients with cancer: High, strong strength of evidence with INITIAL ANTICOAGULATION and VTE the recommendation may involve…

A

Initial anticoagulation: may involve LMWH, UFH, fondaparinux, rivaroxaban, or apixaban.

34
Q

For patients initiating treatment with parenteral anticoagulation what is preferred?

A

LMWH is preferred over UFH for the initial 5-10 days

35
Q

In patients with cancer: High, strong strength of evidence and LONG TERM ANTICOAGULATION and VTE the recommendation may involve…

A

LMWH, edoxaban, or rivaroxaban for at least 6 months are preferred because of improved efficacy over vitamin K antagonists (VKAs). There is an increase in major bleeding risk with DOAC’s, particularly observed in GI and potentially genitourinary malignancies

36
Q

In patients with cancer: Low, weak-moderate strength of evidence and and VTE the recommendation may involve…

A

Anticoagulation beyond the initial 6 months should be offered to select patients with active cancer, such as those with metastatic disease or those receiving chemotherapy

37
Q

PE Treatment based on Classification: Low risk

A

Therapeutic anticoagulation

38
Q

PE Treatment based on Classification: Intermediate risk

A

Anticoagulation, thrombectomy or catheter-directed thrombolytics, then therapeutic anticoagulation

39
Q

PE Treatment based on Classification: high risk

A

IV thrombolytics then therapeutic anticoagulation

40
Q

Plasminogen is present in the blood stream, but it is also bound to fibrin clots…when it is bound it……

A

stabilizes the clot

41
Q

Active plasminogen is called…

42
Q

Plasmin degrades…

A

fibrin clots

43
Q

Thrombolytics activate ______

A

plasminogen –> plasmin and degrades the fibrin clots

44
Q

Alteplase fibrin specificity

A

non specific

45
Q

Alteplase half life

46
Q

Tenecteplase half life

A

90-130 minutes

47
Q

Alteplase dosing

A

bolus followed by infusion

48
Q

Tenecteplase fibrin specifity

A

specific to clot bound fibrin

49
Q

Medications used for CDT…

A

Heparin, Alteplase

49
Q

Tenecteplase dosing

50
Q

Catheter Directed Thrombolytics (CDT) are used to…

A

break up clots
there are holes in the catheter to do this

51
Q

Types of CDT

A

Unifuse and EKOS

52
Q

What is Unifuse

A

Without ultrasound

53
Q

What is EKOS

A

EkoSonic Endovascular System
With ultrasound
Device to deliver catheter directed thrombolytics + ultrasound waves

54
Q

EKOS may be ______ effective at breaking up clots than _____

A

MORE, CDT alone

55
Q

In patients with VTE and no cancer we suggest…

A

Dabigatran, rivaroxaban, apixaban, or enoxaban over vitamin K antagonist (VKA) therapy

56
Q

For patients with VTE and no cancer who are not treated with Dabigatran, rivaroxaban, apixaban, or enoxaban we suggest…

A

VKA therapy over LMWH

57
Q

In patients with an unprovoked proximal DVT or PE who are STOPPING ANTICOAGULANT THERAPY it is suggested to take….

A

Aspirin to prevent recurrent DVT (unless there is a contraindication to it)

58
Q

In patients with proximal DVT or PE take…

A

3 months of anticoagulant therapy

59
Q

In patients with UNPROVOKED VTE: Low-moderate bleeding risk:

A

Extended anticoagulant therapy (no scheduled stop date)

60
Q

In patients with UNPROVOKED VTE: High bleeding risk:

A

3 months of anticoagulant therapy

61
Q

In patients with DVT of the leg or PE and ACTIVE CANCER it is recommended…

A

to extend anticoagulant therapy (no scheduled stop date)

IPC CARDIOLOGY 2 JEN (6 decks)

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