Venous Week 6 Flashcards
What are treatments for a DVT based on?
They are based on a patient’s medical conditions and history.
What does anti-coagulation mean?
Blood thinners.
“Anti”→ means againts
“Coagulation”→ means blood clot.
What are anti-coagulation medication used for?
They are used to prevent the coagulation or clotting of blood by thinning the blood and changing the clotting factors in the blood.
Who are anti-coagulation medication given to?
- Patients has been diagnosed with a DVT/blood clot.
- Prevenative (prophylactically) care for a patient who is at high risk for a DVT/blood clot.
- Patients having an orthepedic surgery.
- Patients who are critically ill or have been hospitilzed for long periods of time.
What are the two most common blood thinners used to treat DVT?
- Heparin
- Coudamin
How is Heparin administered?
Intravenous.
How is coudamin administered?
Orally.
What does heraprin do?
It prevents extension and embolization of thrombus.
Does herparin dissolve a blood clot?
It does not dissolve a blood clot.
Where is heparin administered?
It is administered in a hopsital setting only.
When is heparin usually given in the hospital?
It is often given at the bedside “prophylactically” to prevent blood clots in sick and bedridden patients.
What are some of the negatives of heparin?
- Wear off quickly and does not last long.
- Uncomfortable for the patient.
- Injection.
- Burns when administered.
- Bruising.
- HIT (heparin induced thrombocytopenia)
- It causes a significant drop in platelet count resulting in hypercoaguability.
What is HIT?
(Heparin Induced Thrombocytopenia)
- Causes platelet drop and results in hypercoagulability.
- This a paradoxical reaction= opposite affect.
What happens to patients who become HIT positive?
They are extremely at risk for clotting.
This can be life and limb threatening.
What medication is a low molecular weight heparin?
Lovenox
How can Lovenox be administered?
It is administered subcutaneously.
Where can Lovenox be administered?
It can be administered at outpatient centers, and be given to themselves in their own home.
Why is the low molecular weight heparin perferred?
- Fewer complications.
- Effects last longer than heparin.
What are some of the negatives of Lovenox?
- HIT can occur but with much less risk than heparin.
- Uncomfortable for patient.
- injection.
- causes bruising.
What is the most common ORAL anticoagulant?
Coumadin AKA warfarin.
What is the difference between coumadin and heparin?
Coumadin→orally→.administered in an outpatient setting.
Heparin→intravenous→administred in hospital settings
Is coumadin short term or long term?
It is used long term. (can be lifelong)
What is coumadin used for?
- Treatment of DVT & PE
- Also used to treat arterial thrombosis.
- Patient with arterial bypass grafts.
- For patients who have artial fibrilation. (higher risk for forming clots in the heart.)
Does coumadin break up or dissolve a thrombus?
no, it does not but it prevents the formation of thrombus or the extension of a thrombus.
What are some of the negatives of coumadin?
- Slow onset.
- takes approx. 36 hrs to become effective.
- Slow offset
- takes approx. 2 days to wear off
- Vitamin K contraindicates effects (lessens or makes ineffective.)
- Patients blood needs to be constantly monitored.
- Dosage often changes due to lab values.
While taking coumadin, the blood needs to be monitored very closely to make sure?
- The anticoagulation is effective & working.
- The blood is not getting to thin.
How often is blood monitored to make sure there isnt any adverse effects from coumadin?
weekly.
What is some of the blood work that is done to check for any adverse affects from coumadin?
- Prothrombrin time (measures how fast blood is clotting)
- INR/international noromalization ratio (measures how fast blood is clotting)
- PPT/Partial prothrombin time (detects clotting abnormalities)
What are some of the newly approved oral anticoagulants?
- Xarelto
- Pradaxa
- Eliquis
Do the newer approved anticoagulants require extreme montioring like coumadin does?
No.
What are 3 treatmeants for a DVT?
- Transcatheter Thrombolysis
- Venous Thrombectomy
- IVC filters
What does a transcatheterthrombolysis do?
- “Lyse” means to dissolve or break down.
- A catheter is inserted within the leg and medication is administered directly into the clot.
- GOAL: Rapidly dissolve the clot and restore flow.
Where are thrombolytics usually used in?
Used in larged veins of the iliofemoral level or for extensive occlusion DVT.
What is the most common thrombolytic?
TPA (tissue plasminogen activator)
What is a venous thrombectomy?
- Surgical removal of thrombus.
- “thromb” means clot or thrombus
- “ectomy” means to remove
What is an IVC filter?
- Metal umbrella-like structure.
- It is inserted through a peripheral artery.
- Placed in the inferior vena cava.
- It acts as a basket case or net that catched emboli coming from the leg.
- It prevents emboli from traveling to the lungs.(pulmonary embolis)
Do IVC filters treat DVT?
No, but they prevent the primary complications.
(Pulmonary Embolism)
Who usually gets an IVC filter?
Patients who…
- Cannot be anticoagulated.
- At high risk for DVT and undergoing surgery.
How long can permanent IVC filters be left?
Can be left for a period of time.
Are IVC filters hard to remove?
No, they are easily placed and removed.
What must a patient undergo before getting their IVC filter replaced/removed?
Patients will undergo a venous duplex exam of the legs before their filter gets removed to make sure there are no acute clots in the legs.
What are some side effects from a temportary IVC filter?
If left too long and/or the struts break or the filter migrates, it can lead to:
- Puncture
- Embolism
What is a venous disease?
Issues and/or conditions with the veins other than DVT.
What are some venous disease or conditions that may be results of DVT?
- Phlegmasia Alba Dolens.
- Phlegmasia Cerulea Dolens
- Venous Gangrene.
- Postphlebitic Syndrome (venous insufficiency)
Know the abdominal anatomy:
What is May-Thurner syndrome?
- Left common illac vein is compressed against the L5 vertebrae by the right common illac artery.
- results in “extrinsic compression”
- compression can be caused by:
- enlarged lymph nodes
- tumor
- ect.
- compression can be caused by:
- results in “extrinsic compression”
What are the risk factors for May-Thurner syndrome ?
- middle aged.
- Postpartum
- Female occurence is greater than in male.
What do patients with May-Thurner syndrome present with?
- Unilateral left leg swelling.
- DVT in left leg.
How is May-Thurner diagnosed by?
- Duplex Ultrasound
- visualize compressions
- diagnose DVT
- follow up with patients who have May-Thurner syndrome.
- CT angiography
- Venography
What are the treatments for May-Thurner syndrome?
- Anticoagulation.
- Endovascular treatment.
- Surgery.
How is an endovascular treatment done for May-Thurner syndrome?
- It is done with a catheter inserted into the groin vessel.
- Balloon angioplasty and stenting of the left common illiac vein.
- Place an IVC filter
How is surgery done for the treatment of May-Thurnery syndrome?
- Bypass (from IVC to left common illiac)
- Transposition of the right common illiac artery (remove or reposition)
What is Phlegmasia Alba Dolens?
- It is the decrease of venous drainage as a result of acute illiofemoral DVT.
- Capillary circulation is obscurred by edema resulting in arterial spasms.
What are the causes of Phlegmasia Alba Dolens?
- Hypercoaguability
- Extensive venous thrombosis
What are the risk factors for Phlegmasia Alba Dolens?
- Middle Age
- Pregnancy
- Occurs in females more than males.
What are the physical characterisitics of Phlegmasia Alba Dolens?
- Swollen
- Pale “white” discoloration of the leg.
- Cool to the touch.
- Pulseless
What are the treatments for Phlegmasia Alba Dolens?
- Anticoagulation
- Compression stockings
- Thrombolytics
- Thromboectomy
- Amputation
What is Phlegmasia CURULEA Dolens?
It is massively decreased venous return due to extensive DVT at multiple levels.
(illiofemoral, calf and their collaterals)
How is the venous flow affected by Phlegmasia Cerulea Dolens?
It is vastly obstructed therefore reducing arterial flow.
What are the causes of Phlegmasia Cerulea Dolens?
- Hypercoguability
- Trauma
- Cancer
What are the risk factors for Phlegmasia Cerulea Dolens?
- Middle aged
- Post-OP
- Occurs in females more than males
- May-Thurner syndrome
What are the physical characteristics of Phlegmasia Cerulea Dolens?
- Blue discoloration to the leg.
- Cool to the touch
- Swollen
- Absent arterial pulses
What are the treatments of Phlegmasia Cerulea Dolens?
- Thromboectomy
- Amputation
- Thrombolytics
- Aggressive anticoagulation
- Extensive leg elevation.
What is venous gangrene?
Venous gangrene is the actual necrosis of the tissue due to the massive venous outflow and arterial inflow obstructions.
What causes venous gangrene?
- No venous return or blood leaving the leg.
- No arterial circulation getting to the tissue via capillaries.
This results in tissue death.
What can be a result from Phlegmasia Cerulea Dolens?
Venous gangrene
What is venous insufficiency known as?
Postphlebetic Syndrome.
When is there venous insufficiency?
Occurs when there is poor venous return due to non-functioning valves.
What are the mechanisms of venous insufficiency?
- The non-functioning valves results in the inability for the blood to travel proximally to the heart (valvular incompetence)
What does valvular incompetence result in?
Results in increased ambulatory(standing) venous pressure.
(venous hypertension)
What is the path of the blood?
Arteries→Arterioles (O2 gets transferred to tissue)→Capillaries→Venules→Veins
When venous pressure increases, what happens to the microvasculature (venules and capillaries) pressure?
It increases, which results in edema and red blood cells getting released into the tissue.
What happens when RBC break down in the tissues?
Hyperpigmentation occurs which is called lipodermatosclerosis.
What causes ulceration?
O2 being absorbed into the tissues.
Where does venous insufficiency typically occur?
In the gaiter area.
What is considered the gaiter area?
Between the calf and ankle.
Approximately, How many people suffer from venous insufficiency?
500,000
What are the risk factors for venous insufficiency/postphlebetic syndrome?
- Anything that causes damages to a valve will causes valvular incompetence and subsequent insufficiency.
- Venous thrombosis (DVT)→80% of patient with DVT will get a CVI
- Occupations that require long sessions of standing or sitting.
- Female
- Genetic/Family history
- Age
- Pregnancy
What are the treatments of venous insuffiency?
- Compression stockings (decrease venous pressure)
- Leg elevation
- Bandaging and proper skin care with ulceration
- Sclerotherapy
- Vein stripping (removal of superficial veins)
- RFA (radiofrequency ablation) of GSV, SSV, or perforaters.
