VTE, bleeding and other things

Question 1

what drug can be used for subarachnoid haemorrages

Answer 1

nimodipine (CCB)

Question 2

when is UFH used over LMWH

Answer 2

renal impairment

Question 3

NOACs are only licensed following surgery for what type of surgery

Answer 3

knee and hip replacement

Question 4

how long after surgery do we continue VTE prophylaxis

Answer 4

5-7 days or until mobile

extend to 28 days following major cancer of abdo or pelvis (and some other surgeries depending on local protocol)

Question 5

post VTW how long to you continue herparin for when starting warfarin

Answer 5

at least 5 days or until the INR has been 2 or over for over 24 hours

Question 6

laboratory monitoring for UFH is essential, but what are we measuring?

Answer 6

APTT

Question 7

What anticoagulant is best in pregnancy and why

Answer 7

heparin - because it does not cross the placenta

Question 8

in pregnancy when is LMWH chosed over UFH (2)_

Answer 8

lower incidence of HIT and osteoporosis of the jaw

Question 9

why should you be cautious with dosing heparin in pregnancy?

Answer 9

eliminated more rapidly so different dosing requirements

Question 10

what can be used to reverse heparin?

Answer 10

protamine (but this only partially reverses the effects of LMWH)

Question 11

what is given for acute management of ischaemic stroke (to dissolve clot)?
within what time frame?

Answer 11

alteplase

4.5h

Question 12

When is aspirin initiated post stroke?

Answer 12

24 hours after thrombolysis (or ASAP if thrombolysis is not given)

Question 13

If a patient present with AF following a stroke do you treat with antiplalets or anticoagulants

Answer 13

antiplatelets (aspirin) as with any ischemic stroke

ditto if someone is anticoagulated for a heart valve - stop their anticoagulant temporarily and use antiplatlets

…ANTI-PLATELETS FOR EVERYONE

Question 14

when should you treat hypertension post stroke

Answer 14

not straight away as this can reduce cerebral perfusion

Question 15

how long is asprin given post stroke - and then what

Answer 15

asprin 300mg 2 weeks

then clopidogrel 75mg

Question 16

In summary what long term treatments would you expect someone to be on post stroke

Answer 16

clopidogrel 75mg
BP control
statin

Question 17

What BP do you aim for post stroke

Answer 17

130/80

Question 18

what would you not use to control BP post stroke unless indicated for co-existing condition

Answer 18

beta blockers

no idea why it’s just what the BNF says

Question 19

what might be given long term following cerebral haemorrage

Answer 19

BP control

- you should generally avoid statins tho (who knows why?)

Question 20

lifestyle advice for Raynauds

Answer 20

stop smoking

avoid cold

Question 21

naftidrofuryl, cilostazol and inositol are treatments for

Answer 21

intermitent claudication (also lifestyle factors to reduce CV risk may improve)