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C/R > VTE Prophylaxis > Flashcards

VTE Prophylaxis Flashcards

1
Q

What is a VTE?

A

What is a VTE?

CLOT OCURING IN THE venous circulation

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2
Q

types of VTE

A

types of VTE

  1. DVT
    a. usually occurs in a lower extremity
    b. due to blockage (thrombosis=clot in diseased vessel)
    c. rarely fatal
  2. Pulmoary embolism
    a. occurs in the lung
    b. usually due to dislodged blockage
    c. can be fatal
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3
Q

Reasons for clot formation

A

Reasons for clot formation

  1. Hypercoagulable state
  2. vascular injury
  3. circulatory stasis
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4
Q

Risk Factors

A

Risk Factors

  1. Hypercoagulable state
    a. malignancy
    b. pregnancy
    c. inflammation
    d. factor V Leidan
    e. PRotein C/S deficiency
    f. oral contraceptives (especially estrogen)
  2. Circulatory Stasis
    a. hospitalization
    b. surgery
    c. obesity
    d. Long distance Travel
  3. Vascular Injury
    a. Orthopedic Surgery
    b. Trauma
    c. Venous catheters
    d. smoking
  4. Multiple Components
    a. history of VTE
    b. Age (older= inc risk)
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5
Q

Goals Of Treatment of VTE prophylaxis

A

Goals Of Treatment

  1. Prevent VTE from occurring in high risk patients
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6
Q

PADUA Score

What is it?

A

determines if someone is a good candidate for VTE prophylaxis

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7
Q

PADUA SCORE

categories

A

PADUA SCORE

Risk Factor Score
active cancer 3
previous VTE 3
reduced motility 3
Known genetic hyper coagulable 3
condition
recent trauma/ surgery (within 1 month) 2
> 70 years old 1
Cardiac or resp. failure 1
acute MI or ischemic stroke 1
acute infection or rheumatologist 1
disorder
Obesity (BMI >30) 1
Hormonal Treatment 1

Score <4: Low risk of VTE and generally does not require prophylaxis

Score>/= 4: thromboprophylaxis is recommended for non pregnant patients without contraindications (major bleeding, low platelets) who are > 18 years old.

MAGIC NUMBER IS 4

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8
Q

Non Pharmacologic VTE prophylaxis treatment

A

Non Pharmacologic

  1. Ambulation
  2. graduated Compression stocking
  3. sequential compression devices (SCDs)
  4. Inferior vena cava filter
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9
Q

general pharmacologic treatment

A

low dose anticoagulation

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10
Q

Heparin (Unfractioned Heparin UFH)

Class:Parental anticoagulant

Indication:

Mechanism of Action:
Effects of mechanism of Action:

Route of administration:

Dosing:

Adverse Effects:

Absolute Contraindications:

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI-

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Heparin (Unfractioned Heparin UFH)

Class:Parental anticoagulant

Indication: Anticoagulation- Prophylaxis and treatment of thromboembolic disorders (e.g, venous thromboembolism, pulmonary embolism) and thromboembolic complications associated with atrial fibrillation; prevention of clotting in arterial and cardiac surgery; as an anticoagulant for blood transfusions, extracorpeal circulation, and dialysis procedures

Mechanism of Action: Heparin potentiates antithrombin. Antithrmbin is a natural anticoagulant in the body. Antithrombin decreases transformation from Prothrombin to thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: SubQ (Prophylaxis) IV (treatment)

Dosing: 5000 units Q8-12 HOURs
BMI >/= 40 kg/ m^2: 7500 q8-12 hours

Adverse Effects: thrombocytopenia, Heparin Induced thrombocytopenia

Absolute Contraindications: hypersensitivity, severe thrombocytopenia, History of Heparin induced thrombocytopenia with thrombosis.

Half life: 1-2 hours (IV)

Pregnancy: –

Warning/ Precautions:–

DDI-

Body Weight Considerations: Higher body weight may require higher dosing

Renal Adjustments:None

Monitoring Parameters:

  1. Monitor Anti-Xa levels q 4-6 hours or aPTT that corresponds to Anti-Xa levels
  2. Monitor in obese patients, patients with renal dysfunctions, and pregnant patients

Pearls: Workehorse in the hospital, rarey used outpatient

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11
Q

heparin dosing for VTE prophylaxis

A

5000 units q8-12 hours

if BMI > 40 kg/m^2 7500 units q8-12 hours

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12
Q

Low Molecular Weight Heparin

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

Dosing:

Adverse Effects: –

Absolute Contraindications:–

Half life: approx.1

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:

Monitoring Parameters:

Pearls:

A

Low Molecular Weight Heparin

Class:Parental anticoagulant

Indication: Anticoagulation

Mechanism of Action: potentiates antithrombin. Antithrmbin is a natural anticoagulant in the body. Antithrombin decreases transformation from Prothrombin to thrombin. ALSO inactivates Factor Xa. Factor Xa cleaves Prothrombin to generate thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: SubQ (can really be given IV)

Dosing:30 units BID

Adverse Effects: –

Absolute Contraindications:–

Half life: approx.12 hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: BMI >/= 40 kg/m^2

Renal Adjustments:CrCl < 30 mL/min

Monitoring Parameters:
1. Monitor Anti-Xa levels q 4-6 hours or aPTT that corresponds to Anti-Xa levels
2. GOAL: Anti Xa: ).0.3-0.7 units/ mL (aPTT will be dependent on lab)
Monitor Hemoglobin, hematocrit, platelets

Pearls:Commonly used in the hospital, can be given outpatient

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13
Q

LMWH dosing for VTE prophylaxis

A

30 units BID

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14
Q

Fondaparinux (Arixtra)

Class:
Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

Dosing:

Adverse Effects: –

Absolute Contraindications:–

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Fondaparinux (Arixtra)

Class: anticoagulant

Indication: Anticoagulation

Mechanism of Action: Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: SubQ and IV. no oral option

Dosing: 2.5 mg daily

Adverse Effects: –

Absolute Contraindications:–

Half life: 17-21 hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: avoid weight <50 kg

Renal Adjustments: avoid use in CrCl < 30 mL/min

Monitoring Parameters:
1. Monitorhgb, hematocrit

Pearls: Does not contain pork, can be used for select patients wishing to avoid

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15
Q

Fondaparuniz dosing for VTE prophylaxis

A

2.5 mg daily

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16
Q

Rivaroxaban (Xarelto)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

DOSE:
Adverse Effects:–

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI:

Body Weight Considerations: o

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Rivaroxaban (Xarelto)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: in VTE prophylaxis: 10 mg daily

Adverse Effects:–

Absolute Contraindications: –

Half life:5-9 hours

Pregnancy: –

Warning/ Precautions:–

DDI: major substrate of CYP3A4

Body Weight Considerations: okay in use >120 kg or BMI >/= 40 kg/ m^2

Renal Adjustments: a fib: doe adjust CrCl 15-50 mL/ min: 15 mg daily
avoid use CrCl<15 mL/min

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
Best studied DOAC in obese patients

17
Q

Apixaban (Eliquis)

Class:

Indication:

Mechanism of Action:

Effects of mechanism of Action:

Route of administration:

DOSE:

Adverse Effects:–

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI:

Body Weight Considerations:

Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Apixaban (Eliquis)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Facotr Xa inhibitor. Factor Xa is an enzyme apart of the coagulation cascade that is responsible for cleaving prothrombin, into thrombin.

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: VTE prophylaxis: 1.5 mg BID

Adverse Effects:–

Absolute Contraindications: –

Half life: 12 hours

Pregnancy: –

Warning/ Precautions:–

DDI: major substrate of CYP3A4

Body Weight Considerations: May require a dose Adjustment if <60 kg (as below)

Renal Adjustments: a fib: adjust dose to 2.5 mg twice daily if 2 or 3 of criteria are met. 1. SCr>1.5, 2. weight < 60 kg 3. Age > 8- years

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
Best DOAC in patients with poor renal function/ ESRD dialysis

18
Q

Dabigatran (Pradaxa)

Class:

Indication:

Effects of mechanism of Action:

Route of administration:

DOSE:

Adverse Effects:–

Absolute Contraindications: –

Half life:

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations:
Renal Adjustments:

Monitoring Parameters:

Pearls:

A

Dabigatran (Pradaxa)

Class: Direct Oral Anticoagulant (DOAC)

Indication: Anticoagulation

Mechanism of Action:Direct Thrombin Inhibitor

Effects of mechanism of Action: Increase bleeding time

Route of administration: Oral

DOSE: VTE prophylaxis: 220 mg daily

Adverse Effects:–

Absolute Contraindications: –

Half life: 12-17hours

Pregnancy: –

Warning/ Precautions:–

DDI: –

Body Weight Considerations: afib: Poor outcomes in those > 120 kg or BMI >/= 40 kg/m^2

Renal Adjustments: afib: CRcL 15-29 mL/min: 75 mg bid, AVOID f < 15 mL/min
VTE: Avoid use CrCl <30 mL/min

Monitoring Parameters:
1Monitor HGB, meatocrit, platelets, serum creatinine

Pearls:
rarely used due to increased risk of GI bleeds compared to warfarin

19
Q

KHORANA Score

What is it used for?

A

determine if someone with cancer needs VTE prophylaxis treatment

20
Q

KHORANA SCORE categories

A

How to determine if someone iWITH CANCERcandidate for VTE prophylaxis?

KHORANA SCORE

Patient Characteristic Score
site of cancer cancer ( stomach, pancreas) 2

site of cancer: lung, lymphoma, gynecologic, bladder 1
testicular, renal

Prechemotherapyplatelet count >/= 350,000 1

Hemoglobin <10 g/dL or used red cell growth factors 1

Prechemotherapy leukocyte count >11,000 1

BMI >35 1

Score>/= 2: High risk outpatients with cancer may be offered thromboprophylaxis with apixaban, rivaroxaban, LMWH, provided there are no significant risk factors for bleeding and no drug interactions

21
Q

what anticoagulants can be used in pts with cancer and khorana score >2

A

apixaban
Rivaroxaban
LMWH

22
Q

apixaban VTE prohylaxis dosing

A

1.5 mg BID

23
Q

rivaroxaban VTE prophylaxis dosing

A

10 mg daily

C/R (12 decks)

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