VTE Flashcards
List risk factors of VTE
• cancer/maligancy
• varicose veins
• long flights
• hx of VTE
• opioid misuses
What happens in the body during pulmonary embolism
• in DVT a blot clot forms in the the deep veins of the legs
• the clot breaks off, travels through the blood stream to the right side of the heart, then into the pulmonary arteries, which supplies blood to lungs
Symptoms of DVT?
• throbbing pain in one calf/thigh
• redness
• swollen veins
• warm skin
• swelling in one leg
Symptoms of PE
• difficulty breathing
• chest pain when breathing in
• coughing up blood
80% of PE start as DVT - true or false
True
Virchows traid is a contributing risk factor to PE, what 3 factors does it include?
& other risk factors of PE
• hypercoaguability
• endothelial injury
• hemodynamic changes
• oestrogen
• pregnancy
Clinical manifestations of PE
• breathlessness
• tachycardia
• pleuritic chest pain
• haemopytsis
• syncope
• hypotension
• confusion
What would be the management for someone with no renal impairment, cancer, anti phospholipid syndrome or haemodynamic instability
1st line: Apixaban or Rivaroxaban
2nd line:
• LMWH for 5 days, then edoxaban or dabigatran
OR
• LWMH + VKA for 5 days or when INR is 2, then give VKA alone
What would be the management for renal impairment?
If CrCl - 15-50, give one of the following:
• apixaban
• rivaoxaban
• LMWH for 5 days then edoxaban or dabigatran
• LMWH or UFH + VKA for 5 days or until INR of 2, then continue VKA
If CrCl is <15
• LMWH
• UFH
• LMWH or UFH + VKA for 5 days or until INR of 2, then continue VKA
What would be the management for active cancer?
One of the following
• DOAC
• LMWH
• LWMH + VKA for 5 days or when INR is 2, then give VKA alone
What is the management for Anti phospholipid syndrome
LWMH + VKA for 5 days or when INR is 2, then give VKA alone
Does unprovoked VTE require cancer investigations?
No
Gratuated compression is used for prophylactic, in which patients is it CI
• stroke
• PAD
• dermatitis
• leg oedema
• neuropathy
What is the prophylactic management of VTE for someone undergoing going elective hip surgery (post surgery)
• LMWH for 10 days, followed by Aspirin - 28 days OR
• LMWH for 28 days, with stockings or Rivaroxaban
What is the prophylactic management of VTE for someone undergoing going elective knee surgery (post surgery)
• Aspirin for 14 days OR
• LMWH for 14 days with stocking or rivaoroxaban
(Low doses of Aspirin)
How long can prophylactic be extended for, for abdominal cancer surgery
28 days post surgery
How long can prophylactic be extended for, for spinal surgery
30 days post surgery
In pregnancy how many times is the risk increase for DVT
4
In pregnancy which leg is most affected by DVT
Left side
In pregnancy does d-dimer level increase or decrease
Increase as the pregnancy progresses
What is the prophylaxis of DVT is normal pregnant women in hospital
LMWH until discharge
What is the prophylaxis of DVT is normal pregnant women in hospital who have had miscarriage or termination?
LMWH, 4-8 hours after event, for 7 days
Pregnant women at high risk of haemorrhage or VTE, should be given
UFH
If reduced mobility- what would be the prophylactic management first line
Graduated compression socks
What is the treatment management for DVT in pregnancy
LMWH until suspected VTE is excluded
What is the duration of long term anticoagulation of secondary prevention when VTE is provoked
• 3 months
• 3-6 months in cancer patients
What is the duration of long term anticoagulation of secondary prevention when VTE is unprovoked
• beyond 3 months
• beyond 6 months in cancer
Is Aspirin licensed in VTE
No
When choice comes between edoxaban and dabigatran - if the patient has CrCL of 30 and over which would you give
Dabigatran
What is the treatment dose in VTE for Rivaroxaban
Start - 15mg BD - 7days
Continue - 20mg OD
What is the treatment dose in VTE for Apixaban
Start - 10mg BD - 7 days
Continue - 5mg BD
Provoking factors of VYE
• pregnancy
• combined pill
• surgery
• bed bound
In which condition should short term anticoagulation for primary VTE not be stoped
COVID-19
Diagnosis VTE
What wells score is DVT most likely and what steps would you take - diagnosis
Score 2 and over
• within 4 hours - proximal vein ultrasound
OR
• d-dimer test, anticoagulant and ultrasound within 24 hours
Positive scan - diagnose and continue anticoagulants
Negative scan - do dimer
• positive - d dimer - second scan
• negative scan - stop anticoagulation
What wells score is DVT less likely and what steps would you take
Score - one and under
Do d dimer test within 4 hours
OR
Intermittent anticoagulation while awaiting regular
Positive - follow if score was 2 and over
Negative - stop intermittent therapy
What wells score is PE most likely and what steps would you take - diagnosis
Score over 4
Immediate CT pulmonary angiography
OR
Anticoagulation whilst waiting
Positive scan - diagnose
Negative scan - suspect DVT
What wells score is PE less likely and what steps would you take
Score 4 and under
D dimer within 4 hours
OR
anticoagulants whilst awaiting results
D-dimer Postive - continue as if score is over 4
D-dimer negative- stop therapy
In general how long can prophylactic be extended for
7 dsys
In general which LMWH is first choice
Fondaparinoux
