VTE and PE Flashcards
What are the risks for venous thromboembolism?
Cesarean delivery, particularly when complicated by postpartum hemorrhage or infection
- obesity
- hypertension
- autoimmune disease
- heart disease
- sickle cell disease
- multiple gestation
- preeclampsia
What are the signs and symptoms of lower extremity VTE?
unilateral extremity edema, erythema, warmth, pain and tenderness. DVT is associated with a positive Homan’s sign on examination by your provider.
How do you evaluate for DVT?
Compression ultrasound with or without color doppler is the primary diagnostic modality for evaluating patients with suspicion for DVT.
How do you manage acute VTE in pregnancy?
Adjusted-dose anticoagulation is recommended for all women with acute VTE during pregnancy. after initial treatment (3–6 months dependent upon the type of VTE event), anticoagulation intensity can be decreased to intermediate or prophylactic dose for the remainder of the pregnancy and for at least 6 weeks postpartum
What thrombophilia evaluation do you perform in a patient with acute VTE?
DNA for factor V and prothrombin gene mutation, APS
How do you initiate and monitor anticoagulation in a patient with acute VTE?
Low-molecular-weight heparin should be administered once or twice daily and subcutaneous unfractionated heparin at least every 12 hours.
Assess anti-xa level 4 hours after dosing (goal 0.6-1.0)
How long do you continue anticoagulation after diagnosis of VTE?
For the entire pregnancy and 6 weeks postpartum.
After initial treatment (3–6 months dependent upon the type of VTE event), anticoagulation intensity can be decreased to intermediate or prophylactic dose for the remainder of the pregnancy and for at least 6 weeks postpartum
How do you counsel a patient about recurrent risk of VTE?
The risk of recurrent VTE during pregnancy is increased threefold to fourfold and 15–25% of all cases of VTE in pregnancy are recurrent events
What are the signs and symptoms of PE?
- Tachycardia
- Tachypnea
- Hypoxemia
- Bloody sputum
What are the options for evaluating a pregnant patient suspected of having PE?
Ventilation–perfusion scanning and computed tomographic (CT) angiography are associated with relatively low radiation exposure for the fetus
*** The American Thoracic Society and the Society of Thoracic Radiology clinical practice guidelines for the evaluation of suspected PE in pregnancy suggest that chest X-ray be used as an initial evaluation, with progression to ventilation perfusion scan if the chest X-ray is normal and CT angiography if the chest X-ray is abnormal
How accurate is a CTPA in diagnosing PE in the pregnant patient?
CTPA has become firmly established as the first-line test for the diagnosis of PE
How do you manage a pregnant patient with PE?
Adjusted-dose anticoagulation is recommended for all women with acute VTE during pregnancy. after initial treatment (3–6 months dependent upon the type of VTE event), anticoagulation intensity can be decreased to intermediate or prophylactic dose for the remainder of the pregnancy and for at least 6 weeks postpartum
What is saddle embolism?
thromboembolus at the bifurcation of the pulmonary artery
What patients are considered candidates for thrombolysis in the setting of PE?
Pulmonary embolism and hemodynamic instability due to increased risk of mortality (50% verses 2% in uncomplicated PE)
What are the risks of TPA in pregnant women with PE?
- Placental aburption
- Hemorrhage
