VTE in Pregnancy Flashcards
risk factors for VTE in pregnancy
age >35 BMI >30 parity >2 reduced mobility multiple pregnancy pre-eclampsia gross varicose veins IVF pregnancy
known inherited thrombophilia, FHx, etc
number of risk factors which triggers starting prophylactic anticoagulation in pregnancy
3 risk factors = start LMWH from 28 weeks
4 risk factors = start LMWH in the first trimester
when is a risk assessment for VTE performed for pregnant patients? (2)
at the booking clinic
after birth
how long will pregnant patients be on LMWH for?
until 6 weeks after birth
when is VTE prophylaxis temporarily stopped?
when going into labour!!
suggest 3 situations in which VTE prophylaxis would not be restarted immediately after birth
PPH
epidural
spinal anaesthesia
suggest an alternative to LMWH when this is contra-indicated
mechanical VTE prophylaxis i.e. compression stockings, intermittent pneumatic compression
suggest why it can be more challenging to rule out a PE in a pregnant patient (2)
the Wells score is not verified for use in pregnancy
D-dimer is useless in pregnancy because it is always raised
suggest an investigation that should be done prior to CTPA in pregnant patients
doppler ultrasound (if you can find the DVT that the PE came from then you would give anticoagulation anyway)
suggest 2 advantages of a CTPA over a V/Q scan
suggest when a CTPA is the investigation of choice
better diagnostically
lower risk of cancer to the foetus
CTPA is the investigation of choice for any patient with an abnormal CXR
suggest an advantage of a V/Q scan
lower risk of breast cancer
how should the dose of LMWH be calculated in pregnancy? (NB the dose is based on patient’s weight)
use the weight taken at the patient’s booking clinic
true or false: treatment for LMWH can be started before a definitive diagnosis is reached
true - it can then be discontinued if the investigations rule out VTE
warfarin/DOACs - breastfeeding?
warfarin is safe
DOACs are not known to be safe and are therefore not used
