VLD - VTE Flashcards
What is Virchow’s Triad
SHE
Stasis
Hypercoagulability
Endothelial Damage
What is the most important risk factor for spontaneous VTE
a. Stasis
b. Hypercoagulability
c. Endothelial Damage
d. NOTA
B
What is the least important risk factor for secondary VTE
a. Stasis
b. Hypercoagulability
c. Endothelial Damage
d. NOTA
B
Of these risk factors, relative
hypercoagulability appears most important in most cases of spontaneous VTE, or so-called idiopathic VTE, whereas stasis and endothelial damage likely play a greater role in secondary
VTE
The following are risk factors for VTE EXCEPT
a. oral contraceptives
b. hospitalization
c. older age >30 y.o
d. long haul travel >6 hours
e. trauma
C older age >40 years
Others: malignancy antiphospholipid syndrome myeloproliferative disorders polycythemia APS recently postpartum state
among others
The following are heritable risk factors for VTE EXCEPT
a. female
b. factor V Leiden mutation
c. Antithrombin
d. Protein C and Protein S Deficiency
A.
male not female
Patient-specific factors associted with Venous thrombosis (3)
DOH
Diabetes
Obesity
Hypertension
T/F it is more common in whites and AfAms than Asians and Native Americans
T
Left Iliac vein may be chronically compressed at the site where the right iliac artery crosses over the left iliac vein. This is a predisposing condition to iliofemoral venous thrombosis and is called
May-Thurner Syndrome
Rogers score 5
Caprini score 0
a. Very Low risk General or abdominopelvic surgery
b. Low risk General or abdominopelvic surgery
c. Moderate risk General or abdominopelvic surgery
d. High bleeding risk
e. High risk
f. High bleeding risk General or abdominopelvic surgery for cancer
A
Rogers score <7
Caprini Score 0
= Very Low Risk
Rogers score 8
Caprini score 1
a. Very Low risk General or abdominopelvic surgery
b. Low risk General or abdominopelvic surgery
c. Moderate risk General or abdominopelvic surgery
d. High bleeding risk
e. High risk
f. High bleeding risk General or abdominopelvic surgery for cancer
B
R 7-10
Caprini 1-2
Caprini Score 5
a. Very Low risk General or abdominopelvic surgery
b. Low risk General or abdominopelvic surgery
c. Moderate risk General or abdominopelvic surgery
d. High bleeding risk
e. High risk
f. High bleeding risk General or abdominopelvic surgery for cancer
E
Caprini score >=5
Rogers Score 11
Caprini Score 3
a. Very Low risk General or abdominopelvic surgery
b. Low risk General or abdominopelvic surgery
c. Moderate risk General or abdominopelvic surgery
d. High bleeding risk
e. High risk
f. High bleeding risk General or abdominopelvic surgery for cancer
C
Rogers score >10
Caprini score 3-4
What is the suggested thromboprophylaxis for very low risk ( Rogers score <7
Caprini Score 0)
No specific thromboprophylaxis
Early Ambulation
What is suggested thromboprophylaxis in low risk surgical patients for general or abdominopelvic surgery? R 7-10 Caprini 1-2
Mechanical prophylaxis
What is suggested thromboprophylaxis in moderate risk surgical patients for general or abdominopelvic surgery?Rogers score >10 Caprini score 3-4
LMWH
LDUH or
Mechanical Prophylaxis
What is suggested thromboprophylaxis in high bleeding risk surgical patients
Mechanical prophylaxis
What is suggested thromboprophylaxis in high risk surgical patients for general or abdominopelvic surgery, Caprini of >=5?
LMWH fondoparinux and mechanical prophylaxis
What is suggested thromboprophylaxis in high risk surgical patients for general or abdominopelvic surgery, for cancer?
Mechanical thrombophylaxis,
Extended-duration LMWH 4 weeks
True about DVT EXCEPT
a. venous thrombosis is thought to begin in an area of relative stasis such as a soleal sinus vein or downstream of the cusps of a venous valve in an axial calf vein.
b. Isolated proximal DVT without tibial vein thrombosis is unusual
c. History and PE are very reliable in diagnosis of DVT
d. DVT has been found by venography or DUS in <=50% of patients in whom it was clinically suspected
C
Hx and PE very unreliable
Extensive DVT of the major axial deep venous channels of the lower extremity with relative sparing of collateral veins causes a condition called ________. This is ccharacterized by pain and pitting edema with associated cyanosis
phlegmasia cerulea dolens
Extensive DVT of the major axial deep venous channels of the lower extremity with involvement of collateral veins, vausing massive fluid sequestration and more significant edema results in a condition known as
phlegmasia alba dolens
The ff can be complicated by venous gangrene and the need for amputation
a. phlegmasia cerulea dolens
b. phlegmasia alba dolens
c. both
d. neither
C; both of them
From the common femoral through the popliteal vein, the primary method of detecting DVT with ultrasound is demonstration what finding?
Lack of compressibility of the vein with probe pressure on B-mode imaging.
Lower extremity DVT can be diagnosed by any of the ff DUS findings EXCEPT
a. lack of spontaneous flow
b. inability to compress vein
c. absence of color filling of the lumen by color flow DUS
c. loss of respiratory flow variation
d. venous distension
NOTA
What is the primary diagnosit variable for DVT?
lack of venous compression on B-mode imaging
What are the 3 vascular lab and radiologic evaluations for DVT?
D VIP DUS Venography Iodine-125 Fibrinogen Uptake Impedance plethysmography
This diagnostic is the gold standard to which other diagnostic modalities for DVT are compared.
Venography
Noninvasive method of diagnosing DVT. Changes in electrical resistance resulting from lower extermity blood volume changes are quantified. a. DUS b. Venography c Iodine-125 Fibrinogen Uptake d. Impedance plethysmography
D
What is a positive result of venography?
failure to fill the deep system with passage of contrast medium into the superficial system or demonstration of discrete filling defects.
Why is venography not currently used in practice?
Invasiveness and complication risk
Treatment options for VTE (4)
COAT
Catheter-directed or systemic thrombolytic therapy
Operative thrombectomy
Antithrombotic therapy
Temporary or permanent vena cava filter placement
