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42 Cards in this Set
- Front
- Back
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What are the risk factors for DVT/PE? |
1. Hospitalization/immobilization 2. Obesity 3. Previous hx 4. Coagulopathy 5. Lower extremity trauma 6. Malignancy |
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What is Virchow's triad? |
1. Venous stasis 2. Hypercoagulable state 3. Endothelial injury |
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What is the clinical presentation of DVT? |
1. Extremity swelling 2. Pain 3. Discoloration 4. Palpable cord 5. Asymptomatic 6. May present with signs of PE |
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What are the most important coagulopathies to remember in DVT? |
1. Factor V 2. Prothrombin gene mutation |
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What is the MCC presentation of DVT? |
1. Asymptomatic 2. MUST HAVE A HIGH INDEX OF SUSCPICION |
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What does a PE show in DVT? |
1. NONE MCC 2. Warmth, swelling, discoloration, Homan's sign + |
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What is the in the ddx for DVT? |
1. Muscle injury 2. Cellulitis 3. Valvular insufficiency 4. Baker's cyst 5. Drug-induced edema |
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What is the primary criterion for dx of DVT using US? |
1. Loss of venous compression 2. Also: abnormal valsalva maneuver |
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What is impedance plethsmography? |
1. BP cuffs inflated to different pressures 2. Looking for changes in volume 3. Very sensitive and specific for DVT in thigh 4. Can cause DVT injuries |
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What is the gold standard to dx DVT? |
1. Venography |
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What are the complications of venography? |
1. DVT 2. Renal failure |
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What is D-dimer? |
1. Fibrin degradation product |
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What is a + D-dimer? |
1. >500 in patients with thromboembolism |
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What % of untreated patients will develop a PE? |
1. 50% |
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What rx can be used to tx PE/DVT? |
1. LMWH 2. Fondaparinux 3. Heparin 4. Warfarin 5. tPa |
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What is the MOA of fondaparinux? |
1. Anti-Xa 2. Once daily subQ injection |
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What do you need to monitor with heparin? |
1. Platelet counts 2. PTT 1.5-2.0x normal |
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What is the INR therapeutic range for warfarin? |
1. 2.0-3.0 |
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What is xarelto? |
1. Rivaroxaban |
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What is the tx sequence for DVT/PE using heparin/coumadin? |
1. Bridge warfarin tx with LMWH or heparin until INR gaps 2. Begin warfarin after 2-3 days |
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When is tPa use indicated in DVT? |
1. ONLY IF LIMB THREATENING |
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What is the MOA of rivaroxaban? |
1. Xa inhibitor |
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What is the MOA of dabigatran? |
1. Oral direct thrombin inhibitor |
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What is the downside to rivaroxaban and dabigatran? |
1. No antidote |
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What is the upside to rivaroxaban and dabigatran? |
1. Short half-life 2. Rapid onset of action 2. No bridging required |
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What leads to indefinite tx for DVT? |
1. Idiopathic DVT 2. Recurrent DVT 3. Inherent coagulopathy |
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How long do you tx first DVT with reversible risk factor? |
1. 6-12 months |
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What is the use of compression stockings in the tx of DVT? |
1. 1 moth after dx, continue for a year |
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What is the use of IVC filters? |
1. Contraindicated to anticoagulant tx 2. Recurrent DVT despite anticoagulant tx 3. Extensive DVT 4. Large PE/DVT |
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How do you tx DVT/PE in a pregnant patient? |
1. SubQ LMWH 2. Switch to UFH two weeks prior to expected delivery 3. Coumadin for 4-6 weeks after 4. IVC filter |
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What is postphlebitic syndrome? |
1. Development of venous insufficiency after DVT 2. Causes permanent damage to venous valves 3. Abnormal exudation of fluid from venous system |
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How do you tx postphlebitic syndrome? |
1. Prevention through compression 2. Can't tx effectively once it manifests |
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What is the presentation of PE? |
1. Asymptomatic 2. Dyspnea, cough 3. Hemoptysis 4. Pleuritic chest pain 5. Ssx of DVT |
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What is a possible presentation of a massive PE? |
1. Systemic arterial hypotension |
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What are the non-imaging diagnostic testing for PE? |
1. D-dimer 2. BNP 3. EKG--- S1Q3T3=right ventricular strain |
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How do you remember the Wells Criteria for DVT? |
1. Don't Die Tell the Team To Calculate Criteria |
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What is the gold standard for dx of PE? |
1. Contrast-enhanced CT |
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What is second-line for dx of PE? |
1. V/Q scanning |
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How do you tx PE? |
1. Same as DVT 2. Target INR for coumadin is 2-3 |
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Who need DVT prophylaxis? |
1. Surgical pts. 2. Medical patients-- 130* risk compared to general public |
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How do you prophylax DVT? |
1. Low dose subQ heparin 2. LMWH--- no HIT 3. Warfarin--- INR 2-3 4. Compression stockings |
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How long should you prophylax DVT? |
1. While hospitalized/immobilized 2. Knee--- 7-10 days 3. Hip--- 28-35 days 4. Hip fracture----- 3 months/until mobile |
