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25 Cards in this Set
- Front
- Back
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what are some of the characteristics a pt with DVT may present with
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palpable cord
discoloration homan's sign |
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why is it difficult to diagnose reccurent DVT
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lingering abnormalities in deep veins
must demonstrate new thrombus formation |
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what labs do you look @ for VTE
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D-dimer
if <500 mcg/L no thrombus |
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what drugs are used in the treatment of VTE
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heparin
LMWH fondaparinux warfarin THESE DRUGS DO NOT DISSOLVE THROMBUS JUST STOP THE PROGRESSION OF EXISTING THROMBUS |
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what thrombolytics can be used in treating VTE and why are they not commonly used
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streptokinase
urokinase alteplase not used often due to 3-4x bleeding risk and no proven effect on mortality reserved for life threatening VTE |
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what is the usual treatment regimen for VTE
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Heparin or LMWH or Fondaparinux + Warfarin
use both drugs for >= 5 days can d/c anticoag when INR in therapeutic range for 2 readings |
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what is the antifactor Xa goal for heparin
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between 0.3 - 0.7 IU/mL
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what is the dosing of heparin for VTE treatment
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80units/kg bolus then 18units/kg/hr infusion
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how often do you monitor heparin in VTE treatment
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every 6 hours monitor aPTT
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what do you do when you monitor heparin
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check aPTT q 6 hrs
check CBC q 3 days guaiac stool sample every day |
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Jill was on a continuous infusion of heparin that was stopped for 3 hrs for surgery when can you start to monitor heparin aPTT again
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must wait 6hrs after heparin was restarted to monitor aPTT
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what are the adverse effects of heparin
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bleeding risk
-women, >65 years osteoporosis -when using 20,000 units qd for 6 months thrombocytopenia |
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what happens to platelets in heparin induced thrombocytopenia
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platelets decrease by 50%
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what agents can you use if HIT occurs
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lepirudin
fondaparinux -continue until platelet count recovers and minimum of 5 day overlap with warfarin |
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what is used for reversal of effects of UH and LMWH
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turn herparin infusion off
protamine 1mg reverses 100 units heparin 1mg reverses 100 units antixa |
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1 mg enoxaparin = #units antiXa
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100 units antiXa
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what do you measure to monitor LMWH
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antiXa
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what dose of Enoxaparin is used in VTE treatment
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1mg/kg SQ bid
for inpatient and outpatient |
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if a pt has a Crcl < 30 what agent is prefered
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UH over LMWH
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pts may experience an allergic reaction to protamine if...
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allergic to fish
previous exposure to protamine |
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what is the fondaparinux dose for VTE treatment
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5mg (<50kg)
7.5 mg (50-100kg) 10 mg (>100kg) |
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what are the contraindications for fondaparinux
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Crcl < 30
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when can you D/C anticoagulant
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when INR is at therapeutic range in 2 measurements
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what is Dalteparin FDA approved for
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VTE prophylaxis but not treatment
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what are contraindications to LMWH
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hypersensitivity to pork products or heparin
HIT active major bleeding |
