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IPFC 3 Midterm 2 > VTE Prophylaxis > Flashcards

VTE Prophylaxis Flashcards

1
Q

What is a major risk factor for VTE? what do 60% of VTE cases occur from

A

Current or recent hospitalization

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2
Q

Which patients are 70-80% of fatal PE’s occur in
non-surgical/surgical

A

non-surgical

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3
Q

How much can anticoagulant prophylaxis reduce the incidence of VTE by?

A

60%

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4
Q

What is the specific standard to meet for anticoagulation prophylaxis

A

Medical and surgical clients at risk of VTE that are 18+

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5
Q

What are the steps for individual based assessment for prophylaxis? (3)

A
  1. Estimate the individual’s risk of developing VTE
  2. Estimate the individual’s risk of bleeding
  3. Determine the appropriate mix of prophylactic methods
    - early ambulation
    - mechanical (GCS, IPC)
    - pharmacologic
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6
Q

What are the steps for group based assessment for prophylaxis?

A
  • use a standardized order set for all patients within a particular group or service
  • encouraged by the canadian patient saety initiative CPSI
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7
Q

What are the 2 tools used to estimate the risk of developing VTE

A
  1. Statistically validated risk stratification tool
    - Modified caprini model
  2. Clinical gestalt (pattern recognition)
    - using clinical experience to recognize patient characteristics/circumstances and making decisions based on them
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8
Q

For estimating the risk of bleeding, what consists of a major bleed risk? (4)

A
  • Fatal bleeding
  • symptomatic bleeding into a critical area/organ (blood in urine/stool, tender abdomen)
  • bleeding that causes a drop in Hemoglobin of 20g/L
  • requiring at least 2 units of blood
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9
Q

T/F Bleeding risk scores properly validated for use in surgical patient

A

False

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10
Q

What are ABSOLUTE contraindications for anticoagulant thromboprophylaxis? (4)

A
  • active bleed
  • clinically-important bleeding
  • platelets under 30 x 10^9
  • major bleeding disorder (hemophilia)
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11
Q

What are Relative contraindications for anticoagulant thromboprophylaxis? (3)

A
  • recent intracranial hemorrhage
  • recent perispinal bleeding
  • recent high bleeding risk surgery (cardiac, spinal, intracranial, major trauma)

Recent = 1-3 months

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12
Q

What are the appropriate mix of prophylactic methods (3)

A
  • early ambulation
  • mechanical (GCS, IPC)
  • pharmacologic
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13
Q

What is the effectiveness of early ambulation alone? Benefits? Harms?

A

No evidence
- immobility is a risk factor so it makes sense to remove it

Benefits:
- decreased length of stay for certain conditions
- improved functional status for older ppl

Harm
- risk of falling if not supervised/assisted or ambulate too early

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14
Q

What is the mechanical method machine called? explain it

A

Intermittent pneumatic compression (IPC)
- inflatable wraps around leg (just calf or full leg)
- pressure + deflation helps venous return to heart
- helping skeletal pump + valvular pump in the veins (Since veins don’t have muscle in their walls)

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15
Q

Intermittent pneumatic compression (IPC) Effectiveness/harm?

A

Effectiveness
- reduces the risk of DVT by 55% and PE by 50% compared to no IPC prophylaxis

Harms:
- Discomfort beneath the cuff
- Skin breakdown (avoid in leg ulcers or peripheral artery disease
- nerve damage (rare)

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16
Q

Mechanical method: graduated compression stockings
Effectiveness?
Harms

A

Effectiveness
- effective for reducing risk of DVT, unsure about PE
- More evidence in surgical patients

Harms
- similar to IPC (discomfort, skin breakdown, nerve damage)
- may worsen arterial blood flow in patients with peripheral artery disease
- possible allergy to material

Disadvantage
- miscellaneous (must be properly fitted by a professional)

17
Q

Compare efficacy of UFH, LMWH, and fondaparinux

A

LWMH similar to fondaparinus
- more effective than low dose UFH

18
Q

LWMH is generally preferred except for? (2)

A
  • Use UFH is renal impairment CrCl <20-30 ml/min or if cost is an issue
  • Use Fondaparinux if patient has a history of HIT (can cross react with HIT antibodies in a patient w a history of HIT)
19
Q

What are the harms for pharmacological therapy? UFH? LWMH?

A
  • all increase the risk of major bleeding
  • UFH may cause HIT (heparin induced thrombocytopenia)
  • LWMH may cross react with HIT antibodies in a patient w a history of HIT
20
Q

When do you start thromboprophylaxis? For who?

A

Non-orthopedic surgery patients
- start 0-2 hours before surgery or 0-12 hours after

21
Q

What is the duration for VTE prophylaxis?

A

Moderate-high risk for VTE
- until hospital discharge at least

Major abdominal-pelvic cancer surgery:
- up to 30 days

22
Q

Who are candidates for mechanical prophylaxis?

A

All Patients with ABSOLUTE contraindications and most with relative contraindications

23
Q

Who would benefit from a specialist assessment (eg. thrombosis team)

A

Patients with a high risk of VTE and a relative contraindication

24
Q

What does group-based assessment imply?
Adv
Disadv

A

Implies that low risk patients can still get prophylaxis

Adv
- easy to do (check boxes on sheet)
- systematic (requires clinician to acknowledge)

Disadv
- may lead to overtreatment of low risk patients (possible harm, usually isn’t very harmful)

25
Q

What do the evidence say about prophylaxis in:
Long-term care/nursing home

A

No sufficient evidence to use it, associated with harm
- DO NOT USE

26
Q

What do the evidence say about prophylaxis in:
Cancer-related

A

YES give only if:
- high risk outpatient for VTE
- no risk factors for bleeding
- no drug interactions

27
Q

What do the evidence say about prophylaxis in:
Long distance air travel

A

In patients with increased VTE risk
- recent surgery
- history of VTE
- postpartum women
- active malignancy

OR ≥2 risk factors -> Combinations of the previous with 1. HRT, 2. obesity or 3. pregnancy

  • use stockings or LWMH for flight 4 hours or longer
  • start 1 hour before flight

Compression stockings are not as efficacious as LWMH for PE

28
Q

If you want to minimize risk of VTE event: use ?
If you want to minimize risk of bleeding: use ?

A

If you want to minimize risk of VTE event: use LMWH
If you want to minimize risk of bleeding: use Stockings

IPFC 3 Midterm 2 (7 decks)

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