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401 - Content > VTE > Flashcards

VTE Flashcards

1
Q

List risk factors of VTE

A

• cancer/maligancy
• varicose veins
• long flights
• hx of VTE
• opioid misuses

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2
Q

What happens in the body during pulmonary embolism

A

• 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

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3
Q

Symptoms of DVT?

A

• throbbing pain in one calf/thigh
• redness
• swollen veins
• warm skin
• swelling in one leg

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4
Q

Symptoms of PE

A

• difficulty breathing
• chest pain when breathing in
• coughing up blood

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5
Q

80% of PE start as DVT - true or false

A

True

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6
Q

Virchows traid is a contributing risk factor to PE, what 3 factors does it include?

A

• hypercoaguability
• endothelial injury
• hemodynamic changes

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7
Q

Clinical manifestations of PE

A

• breathlessness
• tachycardia
• pleuritic chest pain
• haemopytsis
• syncope
• hypotension
• confusion

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8
Q

What would be the management for someone with no renal impairment, cancer, anti phospholipid syndrome or haemodynamic instability

A

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

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9
Q

What would be the management for renal impairment?

A

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

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10
Q

What would be the management for active cancer?

A

One of the following

• DOAC
• LMWH
• LWMH + VKA for 5 days or when INR is 2, then give VKA alone

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11
Q

What is the management for Anti phospholipid syndrome

A

LWMH + VKA for 5 days or when INR is 2, then give VKA alone

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12
Q

Does unprovoked VTE require cancer investigations?

A

No

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13
Q

Gratuated compression is used for prophylactic, in which patients is it CI

A

• stroke
• PAD
• dermatitis
• leg oedema
• neuropathy

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14
Q

What is the prophylactic management of VTE for someone undergoing going elective hip surgery (post surgery)

A

• LMWH for 10 days, followed by Aspirin - 28 days OR
• LMWH for 28 days, with stockings or Rivaroxaban

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15
Q

What is the prophylactic management of VTE for someone undergoing going elective knee surgery (post surgery)

A

• Aspirin for 14 days OR
• LMWH for 14 days with stocking or rivaoroxaban

(Low doses of Aspirin)

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16
Q

How long can prophylactic be extended for, for abdominal cancer surgery

A

28 days post surgery

17
Q

How long can prophylactic be extended for, for spinal surgery

A

30 days post surgery

18
Q

In pregnancy how many times is the risk increase for DVT

A

4

19
Q

In pregnancy which leg is most affected by DVT

A

Left side

20
Q

In pregnancy does d-dimer level increase or decrease

A

Increase as the pregnancy progresses

21
Q

What is the prophylaxis of DVT is normal pregnant women in hospital

A

LMWH until discharge

22
Q

What is the prophylaxis of DVT is normal pregnant women in hospital who have had miscarriage or termination?

A

LMWH, 4-8 hours after event, for 7 days

23
Q

Pregnant women at high risk of haemorrhage or VTE, should be given

A

UFH

24
Q

If reduced mobility- what would be the prophylactic management first line

A

Graduated compression socks

25
Q

What is the treatment management for DVT in pregnancy

A

LMWH until suspected VTE is excluded

26
Q

What is the duration of long term anticoagulation of secondary prevention when VTE is provoked

A

• 3 months
• 3-6 months in cancer patients

27
Q

What is the duration of long term anticoagulation of secondary prevention when VTE is unprovoked

A

• beyond 3 months
• beyond 6 months in cancer

28
Q

Is Aspirin licensed in VTE

A

No

29
Q

When choice comes between edoxaban and dabigatran - if the patient has CrCL of 50 and over which would you give

A

Dabigatran

30
Q

What is the treatment dose in VTE for Rivaroxaban

A

Start - 15mg BD - 7days

Continue - 20mg OD

31
Q

What is the treatment dose in VTE for Apixaban

A

Start - 10mg BD - 7 days

Continue - 5mg BD

32
Q

Provoking factors of VYE

A

• pregnancy
• combined pill
• surgery
• bed bound

33
Q

In which condition should short term anticoagulation for primary VTE not be stoped

A

COVID-19

34
Q

Diagnosis VTE

A
35
Q

What wells score is DVT most likely and what steps would you take - diagnosis

A

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

36
Q

What wells score is DVT less likely and what steps would you take

A

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

37
Q

What wells score is PE most likely and what steps would you take - diagnosis

A

Score over 4

Immediate CT pulmonary angiography
OR
Anticoagulation whilst waiting

Positive scan - diagnose
Negative scan - suspect DVT

38
Q

What wells score is PE less likely and what steps would you take

A

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

39
Q

In general how long can prophylactic be extended for

A

7 dsys

401 - Content (17 decks)

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