VTE prophylaxis Flashcards
What portion of inpatient deaths are attributable to VTEs?
10%
What are the 3 mechanical VTE prophylaxis options?
stockings
intermittent pneumatic compression devices
venous foot pump
Graduated compression stocking or intermitted pneumatic compression devices contraindications?
Graduated compression stockings may be contraindicated in patients with the following conditions:
- peripheral arterial disease,
- peripheral neuropathy,
- recent skin graft,
- inflammatory conditions of the lower leg,
- severe oedema of the leg,
- severe lower limb deformity or morbid obesity where correct fitting or stocking cannot be achieved.
Intermittent pneumatic compression or foot pumps can exacerbate ischemic disease and therefore may be contraindicated in patients with peripheral arterial disease or arterial ulcers.
When would you use warfarin for VTE prophylaxis
never specifically as it’s not as good and INR is a hassle
however if they are on it for other reasons then it may be adequate
what is unfractioned heparin usually called
just ‘heparin’
what are examples of LMWHs?
dalteparin and enoxaparin
What are the differences in unfractioned vs LMW heparin for VTE prophylaxis?
similar efficacy
LMWH once a day only as opposed to 2-3x/ day
LMWH better for orthopaedic surgery
LMWHs are renally cleared however unfractioned is cleared by plasma so may be used in severe renal failure
what is the enoxaparin dose for VT prophylaxis?
20 or 40mg (20 if shit kidney function or low risk surgery/ patient)
How do the factor Xa inhibitor(s) compare to LMWH for VTE prophylaxis?
May be better with similar risk of bleeding. Both apixaban and rivaroxaban can’t be used in very poor renal function
How does dabigatran compare to LMWH for VTE prophylaxis?
about equal
What monitoring should you do in a patient on VTE prophylaxis with LMWH?
CBE (Hb - bleeding and Platelets - HITT)
EUC (if renal function deteriorates then may need to stop)
Clinical (wound site, bruises, anaemia symptoms)
