Venous Thrombosis

Question 1

Summarise Virchow’s triad

Answer 1

Question 2

What score is used to assess DVT/PE risk?

Answer 2

Wells score

Question 3

What are the inherited causes of venous thrombosis

Answer 3

Question 4

What are the acquired causes of venous thrombosis

Answer 4

Question 5

Most common thrombophilia

Answer 5

Factor V Leiden

Question 6

What do you give for DVT prophylaxis?

Answer 6

Question 7

DVT/PE Tx

Answer 7

Question 8

What is the therapeutic INR range?

Answer 8

2-3

Question 9

Why continue LMWH when starting Warfarin?

Answer 9

Warfarin inhibits protein C and S leading to an initial procoagulant phase

Question 10

Duration of Mx for DVT/PE

Answer 10

Clearly provoked - 3 months
Unprovoked - 6 months
Recurrent VTE - lifelong

Question 11

Heparin MOA

Answer 11

Potentiates antithrombin III → inactivates thrombin and factors 9, 10 and 11

Question 12

Does LMWH require monitoring?

Answer 12

No

Question 13

Why use unfractionated heparin vs LMWH?

Answer 13

Renal impairment

Question 14

Heparin antidote

Answer 14

Protamine sulphate

Question 15

Warfarin MOA

Answer 15

inhibits vitamin K epoxide reductase → reduced regeneration of active form of vitamin K → inhibits synthesis of F2, 7, 9, 10 and protein C, S and Z

Question 16

Warfarin risks

Answer 16

Teratogenicity
Skin necrosis
Purple toes

Question 17

Warfarin reversal

Answer 17

IV vitamin K - 6 hours
prothrombin complex concentrate - 30 mins

Question 18

What factors can potentiate warfarin?

Answer 18

Liver disease
P450 enzyme inhibitors
cranberry juice
NSAIDs

Question 19

Summarise target INRs

Answer 19

Question 20

Summarise protocols for raised INR

Answer 20

Question 21

Summarise bleeding and DOACs

Answer 21