VTE Flashcards
Venous thromboembolism and the dosage requirement for them
What is the role of a pharmacist in regard to patients with VTE
To support the safe care of patients by checking for appropriate treatment or chemoprophylaxis
What is taken into consideration as a pharmacist when determining drug treatment.
- Clinical scenario: i.e VTE event or prophylaxis
- Contra-indications and cautions for any drugs
- Choice of drug
- Dose appropriate: Indication, Body weight, Renal function
- Drug interactions
- Intervene if necessary
- Educate patient
What is a VTE
It is a disturbance of the body’s normal blood clotting mechanisms due to:
- Vascular damage
- increased coagulability
- slow blood flow
What are the possible outcomes of VTE.
- Morbidity
- Acute
- Long term complication
- Mortality
What percent of people die within an hour of PE and how many within 30 days
- 20%
- 45%
What are the long term complication that occur after a VTE event
Recurrent VTE
Post thrombotic syndrome
Chronic pulmonary hypertension
What are the risk factors
Personal history of VTE Smoking Family history of VTE Cancer Acute illness Male Surgery Thrombophilia Immobility Heart failure Dehydration Varicose veins Increasing age Pregnancy Obesity OCP/HRT
What are the clinical presentation of deep vein thromboembolism
Red, swollen and painful calf Swelling and oedema Pain and tenderness Discolouration of the skin Skin warm to the touch Superficial venous distention
What tests are the done to determine if a patient has had a DVT
-Ultrasound imaging of veins (compression and doppler)
>Diagnostic test
-D – dimer (product of fibrin degradation)
>Positive result; non-specific but raises suspicion
>Negative result indicates no VTE
>Can be used to priorities patients for ultrasound
What are the presentation of Pulmonary embolisms (PE)
- SOB- shortness of breath
- Chest pain
- Cough and haemoptysis (coughing up blood)
- Hypotension
- Tachycardia
- Low grade fever
- Any chest symptoms in patient with -DVT symptoms
Investigation/Diagnosis for PE
- Take full history an Physical diagnosis
- CTPA: computed tomography pulmonary angiography: Diagnostic test
- D-dimer which is no specific but raises suspicion
- VQ scans (scintigraph) : less reliable than diagnostic test
Classes of VTE treatment
- Anticoagulants
- Oral anticoagulants
- Thrombolysis
- Embolectomy
Examples of anticoagulants
Low molecular weight heparin
Enoxaparin
dalteparin
What dose of enoxaparin is given as a treatment for VTE
- 1mg/kg bd -1.5mg/kg OD for those with low risk of recurrence or PE
- started straight away
How long is the treatment of VTE with enoxaparin for
A minimum of 5 days till oral anticoagulants are established
What is the adjusted dose of enoxaparin in the treatment of VTE in a patient with renal impairment?
1mg/kg OD for severe impairment (eGFR less than or equal to 30)
what is used when LMWH is contraindicated.
unfractionated heparin
what other factor is taken into consideration when prescribing an alternative to LWMH
If there is a high risk of bleeding
Examples of Oral anticoagulants
Warfarin
DOACs/ NOACs: rivaroxaban, apixaban, edoxaban, dabigatran
what is given to counteract excessive bleeding caused by anticoagulants
Protamine
Vitamin K
idarucizumab
Andexanet alfa
What is the purpose of protamine in treating excessive bleeding.
Full reversal of UFH, some reports of partial LMWH reversal
What is the purpose of Vitamin K in treating excessive bleeding.
Reversal agent of Warfarin
What is the purpose of idarucizumab in treating excessive bleeding.
Reversal agent of dabigatran
What is the purpose of andexanet alfa in treating excessive bleeding.
Apixaban or rivaroxaban (direct factor 10a) inhibitors- recently licensed
