VTE Prophylaxis Flashcards
What is a VTE?
What is a VTE?
CLOT OCURING IN THE venous circulation
types of VTE
types of VTE
- DVT
a. usually occurs in a lower extremity
b. due to blockage (thrombosis=clot in diseased vessel)
c. rarely fatal - Pulmoary embolism
a. occurs in the lung
b. usually due to dislodged blockage
c. can be fatal
Reasons for clot formation
Reasons for clot formation
- Hypercoagulable state
- vascular injury
- circulatory stasis
Risk Factors
Risk Factors
- Hypercoagulable state
a. malignancy
b. pregnancy
c. inflammation
d. factor V Leidan
e. PRotein C/S deficiency
f. oral contraceptives (especially estrogen) - Circulatory Stasis
a. hospitalization
b. surgery
c. obesity
d. Long distance Travel - Vascular Injury
a. Orthopedic Surgery
b. Trauma
c. Venous catheters
d. smoking - Multiple Components
a. history of VTE
b. Age (older= inc risk)
Goals Of Treatment of VTE prophylaxis
Goals Of Treatment
- Prevent VTE from occurring in high risk patients
PADUA Score
What is it?
determines if someone is a good candidate for VTE prophylaxis
PADUA SCORE
categories
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
Non Pharmacologic VTE prophylaxis treatment
Non Pharmacologic
- Ambulation
- graduated Compression stocking
- sequential compression devices (SCDs)
- Inferior vena cava filter
general pharmacologic treatment
low dose anticoagulation
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:
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:
- Monitor Anti-Xa levels q 4-6 hours or aPTT that corresponds to Anti-Xa levels
- Monitor in obese patients, patients with renal dysfunctions, and pregnant patients
Pearls: Workehorse in the hospital, rarey used outpatient
heparin dosing for VTE prophylaxis
5000 units q8-12 hours
if BMI > 40 kg/m^2 7500 units q8-12 hours
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:
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
LMWH dosing for VTE prophylaxis
30 units BID
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:
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
Fondaparuniz dosing for VTE prophylaxis
2.5 mg daily
