VTE Prophylaxis

Question 1

Two types of VTE?

Answer 1

deep vein thrombosis (DVT)
pulmonary embolism (PE)

Question 2

__ is the first Sx in about 25% of people who have a PE

Answer 2

sudden death

Question 3

3 parts of Virchow’s triad?

Answer 3

• hypercoagulable state
• vascular wall injury
• circulatory stasis

Question 4

Which guideline suggests prophylactic parenteral anticoagulation over no anticoagulation in acutely ill medical pts?

a. ASH 2018
b. CHEST 2012

Answer 4

a. ASH 2018

Question 5

What PADUA score is associated with low VTE risk?

Answer 5

<=4

Question 6

What PADUA score is associated with high VTE risk?

Answer 6

> 4

Question 7

The Caprini VTE test is much more in depth than the PADUA prediction score

a. true
b. false

Answer 7

a. true

Question 8

What diagnostic test is used for DVT?

Answer 8

ultrasound

Question 9

What diagnostic test is used for PE?

Answer 9

CT

Question 10

D dimer can be used to rule out PE

a. true
b. false

Answer 10

a. true

if D dimer is low very rarely will pt have a clot

Question 11

__ is an indirect Xa inhibitor only

a. enoxaparin
b. heparin

Answer 11

a. enoxaparin

Question 12

__ is an indirect IIa, Xa inhibitor

a. enoxaparin
b. heparin

Answer 12

b. heparin

Question 13

Standard LMWH/enoxaprin dose?

Answer 13

40mg SubQ daily

Lovenox

Question 14

Standard UFH dose?

Answer 14

5000 units SQ q8-12hrs

Question 15

Which has a longer half life, enoxaparin or heparin?

Answer 15

enoxaparin

5-7 hrs vs 1-2hrs for heparin

Question 16

RR has now been in the hospital for 48 hours. He has become less mobile, and the team wants to start him on VTE prophylaxis in order to prevent any complications to his hospital stay. His PADUA risk score is 5 indicating pharmacologic therapy. Based on what we have learned so far, what is the best chemoprophylaxis agent for RR.

a. dalteparin 2500 units BID
b. enoxaparin 40mg daily
c. enoxaparin 100mg BID
d. heparin IV drip

Answer 16

b. enoxaparin 40mg daily

Question 17

What test is used to monitor heparin?

Answer 17

activated partial thromboplastin time

aPTT

also CBC

• hb/hematocrit
• platelets

Question 18

Hospitals rarely perform anti factor Xa assay for enoxaprin monitoring.

a. true
b. false

Answer 18

a. true

expensive

CBC

• hgb/hematocrit
• platelets

Question 19

What is heparin dose for obesity with BMI > 40?

Answer 19

7500 units TID

Question 20

What is enoxaparin dose for obesity with BMI > 40?

Answer 20

40mg BID or 0.5 mg/kg/day

Question 21

What is heparin dose for low body weight < 50kg?

Answer 21

5000 units BID ro TID

Question 22

What is enoxaparin (Lovenox) dose for low body weight < 50kg?

Answer 22

30mg daily

Question 23

No renal adjustment is necessary for heparin in pts with renal dysfunction.

a. true
b. false

Answer 23

a. true

Question 24

What is dose of enoxaparin (Lovenox) in pts with renal dysfunction with CrCl < 30?

Answer 24

30mg daily or switch to heparin

Question 25

Extended VTE prophylactic therapy may be required for the duration of cancer/therapy

a. true
b. false

Answer 25

a. true

Question 26

Trauma pts who underwent major orthopedic surgery need what dose of Lovenox (enoxaparin)?

Answer 26

30mg every 12hrw

Question 27

A pt has a BMI of 42. Which is the best VTE prophylaxis?

a. dalteparin 2500 units BID
b. dalteparin 5000 units TID
c. enoxaparin 40mg daily
d. enoxaparin 40mg BID

Answer 27

d. enoxaparin 40mg BID