VTE Flashcards
what type of DVT leads to > 90% of PE
Proximal DVT - popliteal to heart
DVT + PE
VTE
most common preventable cause of hospital death
VTE
which inherited thrombophilia’s put you at risk for VTE
- factor 5 lieden
- prothrombin 20210A
- deficiency in antithrombin, protein c and S
which hospitalized patients are at highest risk for VTE
- spinal cord injury patients
major trauma - any ortho patient
Reduced mobility alone is
NOT enough to cause a DVT
clinical features of a DVT
- swelling
- pain
warmth
many asmptomatic
investigating a suspected DVT
D-dimer
DVT: doppler
PE: CTPA
D-dimer should never be performed on
inpatients
or
high risk patients
Normal D- dimer rules out
VTE
very accurate test if you’re suspecting a DVT
Doppler
Diagnostic tests for a PE
CT pulmonary angiography
look for DVT - doppler
V/Q perfusion scan
Treating VTE
IV heparin - reduces fibrin formation and thrombosis
SC LMWH -
Warfarin
direct oral anticoags
IV heparin acts on
12, 11, 9, 10, 2
SC LMWH acts on what part of the cascare
2 + 10
Disadvantage of IV heparin
- HIT
- monitoring
If you have kidney dysfunction what should you not use
SC LMWH
disadvantages of new oral anticoags
accumulates in renal dysfunction
not for use with mechanical heart valve
Option 1 for treatment of DVT/PE
LMWH once a day for a week or so
- add warfarin at same time
Option 2 for treatment of DVT/PE
- LMWH daily
when would you only use LMWH
In pregnancy
Option 3 for DVT/PE treatment
oral anticoag - direct one
To treat a massive PE = hypotensive or Rt heart failure
or a massive DVT big clot cant walk
- catheter directed endovascular therapy - tPA
if your clot was provoked by a known factor - surgery trauma your risk of developing a second clot if you are anticoagulated is
VERY LOW
treat for 3 months!
If your clot was unprovoked, or have active cancer or an ongoing risk factor
HIGH RISK
treat longer term
how long till a PE resolves
~ 6 mo
if you’ve had a major ortho surgery what are your VTE prophylaxis options?
Hip/knee replacement LMWH and continue Direct anticoag for 2-6 weeks
Hip fracture = LMWH 2-6 weeks
if you are a high bleeding risk patient and need VTE prophylaxis
use stockings until you can start LMWH
