VTE Flashcards
1
Q
clinical RFs for DVt
A
age > 40 years surgery for malignancy prolonged surgery > 30 minutes delatyed post-op ambulation medical diseases varicose veins
2
Q
most common thrombophilias in pts with VT
A
- overall account for 50% of VTE
1. Factor V Leiden (heterozygote 3x risk, homozygous 50-80x risk, overall 5% risk. incidence 5-8%)
2. prothrombin gene mutatoin (6% of all DVT, 2-4% of population)
3. APAS. acquired. 1-2% population. anti-beta glycoprotein correlates most with risk
4. antithrombin III - 0.1% incidence. 30-50% risk.
3
Q
work-up for suspected DVT
A
- Doppler US of LE: more for femoral and popliteal. not as much for tibial vein or below ankle. sens/spec 91%/99%.
- venograph is gold standard. v invasive. 0.1 mGy exposure if femoral/legs. higher if iliac/pelvic veins
4
Q
Interpretation of wells criteria
A
4 and greater: PE likely (65%)
less than 4: unlikely (15%)
5
Q
work-up for PE
A
- CT pulmonary angiography- sensitivity/specificity 94% for central PE
- VQ scan - sens 8% spec 10%
- EKG- indicating R ventricular strain
6
Q
dosing of heparin
A
DVT: IV 100 u/kg loading dose (min 5000 u)
PE: 150 u /kg IV loading dose
Maintenance dose: 15-25 u/kg/hr
goal PTT at 1.5-2.3
7
Q
dosing of LMWH
A
1 mg/kg BID or 1.5 mg/kg daily
8
Q
complicaitons of heparin treatment
A
- osteoporosis
- alopecia
- thrombocytopenia (HIT: 1) transient 2) true: 5-14 days, PF-4 Ab)
9
Q
lovenox -
how long do you need to hold ppx treatment prior to epidural placement? after procedure? after removal?
A
- hold at least 12 hours before procedure
- restart 12 hours after procedure (if OB pt, can consider 6-12 hrs after procedure)
- restart only after 4 hrs s/p catheter removal regardless of procedure time
10
Q
how to use warfarin?
A
- still choice of treatment to prevent clot recurrence
- start same day or after Hpearin or lovenox. INR goal 2.0 to 3.0
11
Q
special considerations with HIT
A
- suspect with new easy bruising, skin necrosis at heparin site, dramatic thrombocytopenia
- argatroban is preferred new agent
- pt’s are paradoxically at risk of venous and arterial thrombus!
