VTE Flashcards
What is Deep Vein Thrombosis?
A clot that forms in the deep veins of the legs or pelvis
What is Pulmonary Embolus
A clot which arises atone site and travels via the blood stream is referred to as an embolus
What is a thrombus?
Where a clot arises and remains in a particular place
Define an embolus
Where a clot arises at one site and travel via the blood stream
State pharmacist role regarding VTE
Support safe care of patient by checking that appropriate treatment or chemoprophylaxis is given considering: Clinical scenario: i.e VTE event or prophylaxis Contra-indications and cautions Choice of drug Dose appropriate Indication Body weight Renal function
Drug interactions
Intervene if necessary
Educate patient
State the cause of VTE
VTE is caused by a disturbance of the body’s normal blood clotting mechanism, principally due to
Vascular damage
Increased coagulability
Environment of slow blood flow
List the outcome of VTE
Morbidity Acute Long term complications Recurrent VTE Post thrombotic syndrome Chronic pulmonary hypertension
Mortality
20% of patients can die within one hour of PE
45% within 30 days of a PE
What are the risk factors of VTE?
Personal history of VTE Family history of VTE Acute illness Surgery Immobility Dehydration Increasing age Obesity Smoking Cancer Male Thrombophilia Heart failure Varicose viens Pregnancy OCP/HRT use
List the presentation of Pulmonary embolus
SOB Chest pain Cough and haemoptysis Hypotension Tachycardia Low grade fever Any chest symptoms in patient with DVT symptoms
PE investigation and diagnosis
Full history taking and physical examination
CXR and ECG
CTPA - Computed tomography pulmonary angiography
Diagnostic test
Also helps arrive at diagnosis if PE not found
(VQ scan (scintigraphy))
Less reliable diagnostic test
D – dimer (product of fibrin degradation)
Non-specific but raises suspicion
Consider venous ultrasound scan to check for DVT
DVT – investigation/diagnosis?
Full history taking and physical examination
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 prioritise patients for ultrasound
State the treatment of VTE
Anticoagulation
LMWH e.g. enoxaparin 1mg/kg BD (or 1.5mg/kg OD for uncomplicated patients with low risk of VTE recurrence)
minimum 5/7 and until oral anticoagulation established
Renal impairment – Enoxaparin sodium is not recommended for patients with end stage renal disease (creatinine clearance <15 mL/min) due to lack of data in this population outside the prevention of thrombus formation in extra corporeal circulation during haemodialysis.
If LMWH contraindicated due to degree of renal impairment or if high bleeding risk - UFH (unfractionated heparin infusion is needed) infusion adjusted to APTTr
Oral anticoagulant – 3/12 and review
Warfarin – dose adjusted according to INR
Or DOAC (NOACs) e.g. rivaroxaban, apixaban, edoxaban, dabigatran – check dose in BNF
Immediate onset of affect therefore no need for LMWH (except edoxaban)
Thrombolysis
Usually only for acute massive PE
Bleeding risk outweighed by prognosis of condition
Embolectomy
DVT - Clinical presentation?
Typically a red, swollen & painful calf Swelling and oedema Pain and tenderness Discolouration of the skin (redness, occasionally cyanosed) Skin warm to the touch Superficial venous distension
state the treatment for the following conditions:
Prophylaxis of Venous thromboembolic disease
Treatment of DVT and PE
Treatment of unstable angina and NSTEMI
treatment of acute STEMI (patients under 75)
treatment of acute STEMI (patients over 75)
Dosing regimen
2,000 IU (20 mg) SC once dally
100 IU\Kg (1 mg/kg) body weight SC once daily
100 IU/kg (1 mg/kg body weight SC once daily
I x 3,000 IU (30 mg) IV boos plus 100 IU/kg {1mg/kg) body weight SC and then 100 IU/kg (1 mg/kg) bodyweight SC every 24 hours
No IV initial bolus, 100 IU (1 mg/kg) body weight SC and then 100 IU/kg (1 mg/kg) body weight SC every 24 hours
Mechanical prophylaxis of VTE?
Anti-embolism stockings
Calf pumps “IPCC”
Geko device
IVC filter
