VTE Flashcards
How do we treat VTE in pregnancy?
Heparins are used for the management of venous thromboembolism in pregnancy because they do not cross the placenta
LMWH requires a dose adjustment in pregnancy. what is this dose adjustment and why?
Eliminated more rapidly in pregnancy and so needs to be given twice daily.
What is the reversal agent for heparin?
Protamine sulfate - but only partially reverses the effects of LMWH, more effective against heparins.
What is HIT? When can it occur?
Clinically important heparin-induced thrombocytopenia is immune-mediated and does not usually develop until after 5–10 days; it can be complicated by thrombosis.
What are the signs of HIT?
Signs of heparin-induced thrombocytopenia include a 30% reduction of platelet count, thrombosis, or skin allergy. If heparin-induced thrombocytopenia is strongly suspected or confirmed, the heparin should be stopped and an alternative anticoagulant, such as danaparoid, should be given. Ensure platelet counts return to normal range in those who require warfarin
Why do heparins raise K+ levels?
Inhibition of aldosterone secretion
What patients are more at risk of hyperkalemia with heparin treatment?
patients with diabetes mellitus, chronic renal failure, acidosis, raised plasma potassium or those taking potassium-sparing drugs seem to be more susceptible. The risk appears to increase with duration of therapy.
Enoxaparin should be avoided at what CrCl?
Manufacturer advises avoid if creatinine clearance less than 15 mL/minute.
Is anti-factor Xa monitoring required with LMWH?
outine monitoring of anti-Factor Xa activity is not usually required during treatment with enoxaparin, but may be necessary in patients at increased risk of bleeding (e.g. in renal impairment and those who are underweight or overweight).
Dose of apixaban for prophylaxis of VTE following knee replacement surgery
2.5 mg twice daily for 10–14 days, to be started 12–24 hours after surgery.
Dose of apixaban for prophylaxis of VTE following hip replacement surgery
2.5 mg twice daily for 32–38 days, to be started 12–24 hours after surgery.
How long should warfarin be continued for the treatment for VTE?
Usually 3 months - consider for longer if an unprovoked DVT/PE if no risk of major bleeding.
What dose of apixaban should be given for VTE treatment? How long should treatment be continued for?
To treat deep vein thrombosis (DVT) or pulmonary embolism (PE), 10 mg apixaban should be taken twice a day for the first 7 days, followed by 5 mg twice a day for at least 3 months. For the prevention of recurrent disease, people who have completed 6 months of treatment for DVT or PE should take 2.5 mg twice a day.
What does of dabigatran should be given for the treatment of DVT/PE? How long should treatment be continued for?
The recommended dosage of dabigatran etexilate is 300 mg (150 mg twice daily) following treatment with a parenteral anticoagulant for at least 5 days. For people aged 80 years or older and for people having verapamil, the recommended dose is 220 mg (110 mg twice daily). In people aged 75–80 years, people with moderately reduced kidney function, people with gastritis, esophagitis or gastroesophageal reflux, and people at increased risk of bleeding, either dose (300 mg or 220 mg) can be given based on an individual assessment.
Which DOAC must be ‘loaded’ with heparin first before starting treatment for a DVT/PE?
Dabigatrain - must give 5 days of LMWH before can switch to oral.
