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Mat med > VTE > Flashcards

VTE Flashcards

1
Q

Who counts as antenatal high risk for VTE?

A

Any previous VTE except single event related to major surgery

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2
Q

What does being high risk for antenatal VTE constitute?

A

Antenatal prophylaxis with LMWH (high risk)
Refer to trust nominated thrombosis in pregnancy expert / team

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3
Q

What counts as intermediate risk for antenatal VTE?

A

Hospital admission
Single previous VTE related to major surgery
High risk thrombophillia + no VTE
medical comorbidities eg. Cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, SCD, current IVDU
Any surgical procedure eg. Appendicectomy
OHSS (first trimester only)

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4
Q

What medical comorbidities score as intermediate risk for VTE?

A

Cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, SCD, current IVDU

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5
Q

What does intermediate risk for VTW mean?

A

Consider antenatal prophylaxis with LMWH

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6
Q

Other risk factors for VTE
>3
>4

A

> 3 proph from 28/40
4 proph from first trimester

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7
Q

VTE risk factors

A

Obesity (BMI > 30kg/M)
Age > 35
Parity 3 or above
Smoker
Gross varicose veins
Current PET
Immobility eg. Paraplegia, PGP
Family history of unprovoked or E provoked VTE in first degree relative
Low risk thrombophillia
Multiple pregnancy
IVF / ART

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8
Q

Transient VTE risk factors

A

Dehydration
/ hyperemesis : current systemic infection , long distance travel

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9
Q

Fewer than three risk factors

A

Lower risk
Mobilisation and avoidance of dehydration

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10
Q

Any previous VTE except a single event related to a major surgery scores

A

4, requires antenatal prophylaxis with LMWH from booking until post partum period

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11
Q

The following risks score what ?

Hospital admission
Single previous VTE related to major surgery
High risk thrombophillia + no VTE
medical comorbidities eg. Cancer, heart failure, active SLE, IBD or inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with nephropathy, SCD, current IVDU
Any surgical procedure eg. Appendicectomy
OHSS (first trimester only)

A

VTE 3
28/49 until 6/52 PP

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12
Q

What does 4 VTE score mean?

A

Booking into 6/52 PP LMWH

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13
Q

What does 3 VTE score mean?

A

28/40 until 6/52 PP

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14
Q

Postnatal VTE : what scores 4 automatically?

What’s the duration of LMWH?

A

Any previous VTE
Anyone requiring antenatal LMWH
High-risk thrombophillia
Low-risk thrombophillia

At least 6/52 postnatal prophylactic LMWH

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15
Q

Postnatal VTE : what scores intermediate risk 3?

What is the duration of prophylactic LMWH?

A

CS in labour
BMI equal or above 40
Réadmission or prolonged admission (>3days)
Any surgical procedure in the peurperium except immediate repair of the perineum
Medical comorbidities eg. Cancer, heart failure, active SLE, IBD / inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with néphropathie, sickle cell disease, current IVDU

These all score 2

At least 10/7 postnatal prophylactic LMWH

NB if persisting / > 3 risk factors consider extending thromboprophylaxis with LMWH

This is 2/3

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16
Q

Antenatal VTE 2

A

Postnatal 10/7 LMWH

17
Q

Postnatal VTE risks scoring 3

A

Previous VTE provoked by major surgery

Known high risk thrombophillia

Medical comorbidities eg. Cancer, heart failure, active SLE, IBD / inflammatory polyarthropathy, nephrotic syndrome, type 1 DM with néphropathie, sickle cell disease, current IVDU

18
Q

Postnatal VTE risks scoring 1

A

Family history of unprovoked or oestrogen related VTE in first degree relative

Known low risk thrombophillia (no VTE)

Age 36 and above (>35)

Obesity 35>

PET current pregnancy

Parity 3 or more

Smoker

Gross varicose veins

ART / IVF (antenatal only)

Multiple pregnancy

ELCS

Mid-cavity or rotational operative delivery

Prolonged labour (>24 hours)

PPH (>1 litre or transfusion)

Preterm birth <37+0 weeks in current pregnancy

Stillbirth in current pregnancy

19
Q

What scores 2 postnatal VTE?

A

BMI > 40

CS in labour

20
Q

Transient risk factors for VTE postnatal scoring 3

A

Any surgical procedure in the puerperium except immediate repair of the perineum eg. Appendicectomy or postpartum sterilisation

Hyperemesis

21
Q

Transient VTE risk factors scoring 4

A

OHSS (first trimester only)

22
Q

Transient risk factors scoring 1

A

Current systemic infection
Immobility, dehydration

23
Q

What thrombophilias or risk factors score as very high risk?

What do they score?

What is the recommended duration of LMWH?

A

Previous VTE on long term oral anticoagulant therapy

Antithrombin deficiency

Antiphospholipid syndrome with previous VTE

4

Recommend antenatal high dose LMWH and at least 6/52 postnatal LMWH or until switched back to oral anticoagulant therapy

These women require specialist management by experts in haemostasis and pregnancy

24
Q

What scores as high risk for previous VTE?

What is the score?

What is the duration of LMWH?

A

Any previous VTE (except single VTE related to major surgery)

Recommend antenatal and 6/52 postnatal prophylactic LMWH

25
Q

What counts as intermediate risk for thromboprophylaxis in women with previous VTE and / or thrombophillia?

What is their score?

A

3

Asymptomatic high risk thrombophillia - refer to local expert

Homozygous factor V Leiden / compound hétérozygote Protein C or S deficiency - consider antenatal LMWH for 6/52

Single previous VTE associated with major surgery without thrombophillia, family history or other risk factors - consider antenatal LMWH (not routinely recommended)
Recommend LMWH from 28/40 and 6/52 postnatal prophylactic LMWH

26
Q

What counts as low risk for thromboprophylaxis in women with previous VTE and or thrombophillia ?

What would they score?

What LMWH should they have?

A

Asymptomatic low risk thrombophillia (prothrombin gene mutation or factor V lieden)

Consider as a risk factor and score appropriately
Recommend 10 days if other risk factors post partum (or 6 weeks’ if significant family history) postnatal prophylactic LMWH

27
Q

What does very high risk / high risk score and the duration?

A

Booking - 6/52 LMWH

Very High risk = high dose (BD)

High risk = OD dose

28
Q

Who scores as very high risk VTE antenatally?

A

4

Previous VTE on long term anticoagulant therapy (people who take OACs when not pregnant)

Anti thrombin deficiency
Antiphospholipid syndrome with previous VTE

29
Q

Antiphospholipid syndrome scores what with VTE risk?

A

+ previous VTE = 4 - BD dosing

If no VTE, then coiners as asymptomatic low risk thrombophillia (1)

30
Q

Antiphospholipid syndrome scores what with VTE risk?

A

+ previous VTE = 4 - BD dosing

If no VTE, then coiners as asymptomatic low risk thrombophillia (1)

31
Q

What conditions need BD LMWH prophylaxis dosing ?

A

Scores 4

Previous VTE on DOAC

Antithrombin deficiency

Antiphospholipid syndrome with previous VTE

32
Q

What does Factor V Leiden score ?

A

If homozygous / compound heterozygous = 3 intermediate risk

Gene mutation or heterozygous Asymptomatic = low risk 1

33
Q

Contraindications/ cautions to LMWH use

A

Known bleeding disorder (haemophilia, VWF, or acquired coagulopathy)
Active antenatal or postpartum bleeding
Women considered at risk of major haemorrhage (placenta praevia)
Thrombocytopenia (PLT < 75)
Acute stroke in previous 4/52 (haemorrhagic or ischaemic)
Severe renal disease (GFR < 30)
Severe liver disease (PT > normal range / known varices)
Uncontrolled HTN (BP systolic > 200 or > 120 diastolic)

34
Q

When to stop LMWH before IOL

A

Therapeutic LMWH 24 hours before

Prophylactic LMWH 12 hours before

35
Q

When to restart LMWH after IOL / CS

A

Prophylactic 4 hours

Treatment dose 8-12 hours later

Mat med (5 decks)

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