VTE

Question 1

What does VTE include

Answer 1

PE pulmonary embolism and DVT (deep vein thrombosis)

Question 2

What are some risk factors for VTE

Answer 2

Surgery

Trauma

Immobility

Malignancy

Obesity

HRT

Question 3

Symptoms of PE

Answer 3

Chest pain, SOB

Question 4

Symptoms of DVT

Answer 4

Pain in calf, swelling, redness, hot to touch

Question 5

What is the order of bleed risk

Answer 5

Antiplatelets (aspirin and clopi)

Anticoagulants (doacs)

Alteplase (highest risk)

Question 6

Overview of VTE

Answer 6

Question 7

What is good in all types of surgery and also good in CrCl 15-50

Answer 7

Heparin

Question 8

What is good in elective hip/knee replacement surgery after heparin

Answer 8

DOACS
R
AD

Question 9

What surgery can fondaparinux be used in

Answer 9

All

Question 10

When is unfractionated heparin preferred

Answer 10

Renal impairment or increased risk of bleed

Question 11

When should pharmacological prophylaxis be started in hospital

Answer 11

Within 14 days of admission

Question 12

How long should we continue pharmacological prophylaxis after surgery

Answer 12

7 days or until patient is fully mobile

Question 13

What is the VTE treatment

Answer 13

Confirmed DVT/PE - RE

Alternatively LMWH for 5 days then dabigatran even if egfr is less than 30 or edoxaban

Question 14

What should be used in pregnancy?

Answer 14

Heparin - do not cross placenta

LMWH preferred - lower risk of osteoporosis and heparin induced thrombocytopenia

Question 15

What is the duration of therapy for confirmed DVT

Answer 15

At least 3 months

Question 16

What is the duration of therapy for provoked DVT

Answer 16

3 months (3-6 for active cancer)

Question 17

What is the duration of therapy for unprovoked DVT

Answer 17

More than 3 months (more than 6 in active cancer)

Question 18

What is the antidote to heparins

Answer 18

Protamine sulphate

It partially reverses effects of LMWH