VTE Lecture Flashcards
Do DVTs/SVTs form in upper or lower extremitites?
DVT/SVTs in upper extremities often form from complications from…
PICC or PORT lines
for VTE, rates among highest risk populations can be as high as __% among those not receiving thromboprophylaxis
80%
Critical ill
Cancer
Stroke
Pregnancy
MI
Age >75
Previous VTE
Prolonged immobility
Renal failure
Inherited hypercoaguable states
high risk populations for VTE
No pharmacotherapy
Early and often ambulation
Mechanicals SCDs
..used for what population of ppl for VTE prevention
Non-high risk
- *pharmacotherapy tx!!** (LMWH or UFH)
- SQ Lovenox 40 mg daily
- SQ Heparin 5000 units q12
VTE prevention for what population of ppl?
High risk
(no need to continue pharmacotherapy beyond acute stay unless going to rehab)
What must you watch for if a person is on Heparin?
Heparin Induced Thrombocytopenia (HIT)
*can be immediate or delayed when on Heparin
50% decrease in platelets should be a RED FLAG!!!
Heparin Induced Thrombocytopenia (HIT)
Tx= Stop all Heparin like products
Arixtra=the go to in this situation
Heparin Induced thrombocytopenia (HIT)
Dx:
Lower extremity swelling, pain, discoloration
Palpable cord, + Homan’s sign, edema, discoloration
DVT
Forcibly and abruptyl dorsiflex the pt’s ankle
Pain in calf and popliteal region= positive sign
Homan’s sign (for DVT)
a low probability Well’s Score has a __% negative predicted value
a low probability Well’s score + a negative d-dimer has a __% negative predicted value
low Well’s score= 96%
low Well’s score + negative D-dimer= 99%
3+ Wells Score= ?
1-2 Wells Score= ?
0 or less Wells Score= ?
3+= high probability
1-2= moderate
0 or below= low
Admit to hospital
Ultrasound to confirm dx
Anticoagulation: IV Heparin or SQ Lovenox for a minimum of 5 days!!!
DVT tx
For a DVT, must be on Heparin for at least how many days
5 days
for a DVT….
once INR is at goal and parenteral anticoagulation has been administered for a minimum of 5 days, can safely stop parenteral anticoagulation and rely on ____ alone
Coumadin
Day one for DVT: start Coumadin right away togther with Heparin/LMWH
INR goal=?
2.0-3.0
(can load 10 mg daily x3 days then tailor dose to maintain goal)
PE
Phlegmasia cerulea dolens
=potential complications of?
DVT
What is the changing paradigm in DVT management
*is now considered acceptable for monotherapy (no heparin overlap needed)
Direct oral anticoagulants (Novel Agents)
short half life, 5-9 hours
considered effective immediately
avoid using if eGFR<30
Direct oral anticoagulants (Novel agents)
dyspnea + tachypnea at rest or exertion
pleuritic pain
cough
orthopnea
calf or thigh pain +/- swelling
wheezing and coarse breath sounds on exam
hemoptysis (13%)
submassive PE
dyspnea + tachypnea at rest or exertion
pleuritic pain
cough
orthopnea
calf or thigh pain +/- swelling
wheezing and coarse breath sounds on exam
hemoptysis (13%)
PLUS hypotension (SBP<90)
RV dilation and dysfunction=BAD SIGN
MASSIVE PE
how do you confirm a PE diagnosis?
CT pulmonary angiography
When do you do a V/Q scan?
If CT is contraindicated
*often cannot get V/Q scans urgently
How do you assess the risk level of a PE?
EKG and TTE (looking for RV dysfunction)
Follow BP closely (SBP <90 is BAD)
If massive PE is amenable to embolectomy (interventional radiology), where should you transfer the pt to?
A tertiary medical center
Which floor should a massive PE be admited to?
What about a submassive PE?
Massive PE= CCU
Submassive PE= med surg with telemetry
When should you get a hypercoag. panel (Factor V, Protein C+S) be obtained?
AFTER initial treatment period (3 months) and anticoagulation has been stopped
What are the indications for an IVC?
If the pt cannot use pharm anticoagulnts (bleeding risk)
*if they developed a complication or recurrence on pharmacotherapy alone
Do all PEs and DVTs need hospitalizations?
No
True or False..
For PE and DVT you should start Coumadin and parenteral anticoagulant at same time
True
