VTE Flashcards
Treatment for acute isolated distal DVT of the leg without severe symptoms
Serial imaging x 2 weeks
Treatment for acute isolated distal DVT of the leg without severe symptoms
Anticoagulation
List the 3 fibrinolytics
Alteplase (tPA)
Reteplase
Tenecteplase
Fibrinolytic most specific for fibrin bound plasmin
Tenecteplase
Fibrinolytic least specific for fibrin bound plasmin
Alteplase
Medications used for catheter directed thrombolysis (CDT)
Heparin and alteplase
What are the two clinical pearls associated with Argatroban?
about 85% hepatobiliary elimination
will elevate INR
True or False: you can transition from a DTI directly to a DOAC
True
When is it appropriate to change from a DTI to warfarin?
after the platelets level is above 150,000
If a patient is on Bivalirubin and has a PTT at baseline and an INR below range what is the proper next step?
Restart the drip
What is the INITIAL treatment recommendation for a patient with high/strong cancer quality and evidence?
initial anticoagulation can be enoxaparin, heparin, fondaparinux, or rivaroxaban.
Is LMWH (enoxaparin) or heparin the preferred parenteral anticoagulant for high/strong cancer patients?
LMWH is preferred over UFH for initial 5-10 days
What is the LONGTERM treatment recommendation for a patient with high/strong cancer quality and evidence?
LMWH, edoxaban, or rivaroxaban for at least 6mon (improved efficacy over Vit K antagonists)
What is the treatment recommendation for a patient with low/weak cancer quality and evidence?
Offer anticoagulation after 6mon to specific patients who have active cancer (ie: those with metastatic disease or receiving chemotherapy)
What are the most commonly affected veins in proximal DVT?
Popliteal and superficial femoral vein
What is provoked DVT?
A DVT caused by a known event
What are common causes of provoked DVT?
Long distance travel Surgery Hospitalization
What is unprovoked DVT?
A DVT that has no identifiable cause
In patients with VTE and no cancer, what do we use for treatment?
Dabigatran, rivoroxaban, apixaban, or edoxaban
In patients with VTE and no cancer, but not treated with dabigatran, rivoroxaban, apixaban, or edoxaban, what do we use for treatment?
Warfarin
In patients with unprovoked proximal DVT/PE who are stopping anticoagulant therapy, what do we use for treatment?
Aspirin (if patient does not have CIs to aspirin)
How long is anticoagulant therapy used in patients with proximal DVT/PE?
3 months
How long is anticoagulant therapy used in patients with unprovoked VTE and a low to moderate bleeding risk?
Extended period of time (no scheduled stop date)
How long is anticoagulant therapy used in patients with unprovoked VTE with a high bleeding risk?
3 months
How long is anticoagulant therapy used in patients with a DVT in the leg or PE and also have active cancer?
Extended period of time (no scheduled stop date)
What are the 4 recommended anticoagulation agents for initial DVT treatment in cancer patients?
LMWH, UFH, Fondaparinux, Rivaroxaban
Site of cancer: stomach, pancreas
+2
Site of cancer: lung, lymphoma, gynecologic, bladder, testicular, renal
+1
Prechemotherapy platelet count ≥ 350,000
+1
Hemoglobin < 10g/dL or use red cell growth factors
+1
Prechemotherapy leukocyte count > 11,000
+1
BMI ≥ 35
+1
What treatment is offered to high-risk outpatients with cancer?
Thromboprophylaxis with Apixaban, Rivaroxaban, LMWH
High risk outpatients with cancer has a Khorana score of ____
≥ 2
What is the caveat of providing thromboprophylaxis with apixaban, rivaroxaban, LMWH to high-risk outpatients with cancer?
Provided that there are no significant risk factors for bleeding and no drug interactions.
