VTE Flashcards
What is the process of thrombus formation
virchows triad
What is virchows triad
Stasis
endothelial injury
hypercoagulability
What allows for blood to flow in the venous system
skeletal muscle
gravity
intrathoracic pressure
What factors can cause a prothrombotic state
trauma
surgery
pregnancy
hormone therapy
medications
infection
prolonged immobility
What are some hyper coagulable states
Protein C&S deficiency
Factor V Leiden
Malignancy
Prothrombin mutations
Antithrombin 3 deficiency
Presentation of DVT
Ipsilateral LE edema
LE erythema
LE pain
LE warmth to touch
What may be seen on physical exam with a DVT
Calf tenderness
palpable cord
superficial vein dilation
Homans sign
What is Homans sign
Calf pain with passive dorsiflexion of the ankle with the knee at 30 degrees
What is the test of choice with a DVT
DUplex venous ultrasound
What is the gold standard for DVT workup
Venogram (not routinely used)
How do you work up a DVT
D-Dimer
duplex venous ultrasound
venogram
When is DVT criteria beneficial
for risk stratification only
Which criteria is used for DVT
wells criteria
What embolism is the worst PE
saddle
What are the locations for PEs
Saddle
Lobar
Segmental
Sub-segmental
What location of a PE is most likely to cause infarct or pleuritis
sub-segmental
What is a saddle pulmonary embolism
PE that straddles the bifurcation of the PA
occludes both right and left pulm arteries
What are common symptoms of a PE
Dyspnea
Pain with inspiration
cough
Leg pain
How may a patient present with a PE
tachypenic
tachycardia
What may be seen on a CXR with PEs
Fleischners sign
westermark sign
hamptoms hump
What is Fleischners sign
Enlarged PA
What is westermark sign
lack of distal pulmonary vasculature
What is hamptoms hump
Wedge shaped pulmonary infarct
What pattern will be seen on an EKG with PE
S1,Q3, T3
What is the preferred diagnostic test for a PE
CTA
If a patient is pregnant, would you still get a CTA if there is suspicion for a PE
Still preferred if there is HIGH suspicion for a PE
or elevated D-dimer
When can a ventilation perfusion scan (VQ) be done for a PE
there must be a normal chest xray first
What is a definitive diagnostic test for PE
Pulmonary angio
When is a PERC score used with PE
when the well’s score <2 to r/o PE instead of D-dimer
When can you NOT rule out PE with PERC rule
if any one of the criteria are present
When is inpatient treatment considered with PEs
Proximal DVT
Significant co-morbidities
Neuro conditions
GI bleed/ liver dysfunction
Active bleeding
HIT / TTP
What is the mainstay treatment for PEs
Anticoagulation for most
*If massive = TPA
-possible embolectomy
-Unfractionated heparin vs LMWH
What form of heparin is preferred in PE treatment
LMWH (Lovenox)
**If CKD need UFH
What are oral anticoagulants that a patient can be put on with PE
Warfarin
DOACs
If a pregnant patient has a PE, how are they treated
LMWH
**NO Coumadin or DOACs
If treating a patient with a PE with warfarin, how long are they on it for
until their INR >2 then D/C
**Called bridging
How often is an INR required if a patient is on Warfarin
2x a week until INR is stable again
If a patients INR on warfarin is 5-9, what do you do
Omit 1-2 doses on Warfarin and administer vitamin K if at a high risk for bleeding
Why are DOACs preferred over warfarin
Less drug interaction, no lab monitoring, quicker onset, lower bleeding risk
Which patients do we look for hypercoagulable states in
<50y/o
significant family hx of VTE
Clot in unusual location
Recurrent clots
Women of child bearing age
What is the preferred PE treatment for cancer patients
DOACs
What is thrombophlebitis
Inflammation of a vein
clot leading to inflammation of deep vein = DVT
What are some causes of thrombophlebitis
**Secondary to PICC lines and IVs
Trauma, pregnancy, varicose veins
What is the most common cause of infection for thrombophlebitis
staph aureus
If a patient gets spontaneous thrombophlebitis, where do they generally occur
GSV
What are some presentations of thrombophlebitis
Pain
Induration
tenderness
palpable cord
linear erythema `
How long do you treat someone with major risk factor fro PE
3months + prophylaxis for subsequent exposures
How long do you treat cancer related PEs
3-6 months or as long as cancer is active
How long do you treat unprovoked VTE
minimum of 3 months
How long do you treat recurrent unprovoked VTE
indefinitely
If a patient is septic with thrombophlebitis, how do you treat them
Vanco + ceftriaxone
How do you symptomatically treat thrombophlebitis
Heat and NSAIDS
