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45 Cards in this Set
- Front
- Back
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What is Virchow's Triad?
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Venous stasis
Hypercoagulable state Vessel injury |
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what % of DVT's are asymptomatic?
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50-60%
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What conditions contribute to venous stasis?
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Immobilizations
CHF, MI, CVA Varicose veins Pregnancy Obesity |
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what are some causes of vessel injury?
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Trauma
Previous DVT Venous catherization Fractures Major surgery |
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What drug is used to treat a pregnant pt with DVT?
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Heparin; don't use LMWH(lovenox)
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name some clinical hypercoagulable states
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Malignancy
Estrogen use Pregnancy |
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When would you use Coumadin when treating pregnant women with DVT?
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only in the second or third trimester
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name some clotting factor abnormalities
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Protein C or S def.
Antithrombin III def. Activated Protein C Prothrombin mutations |
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how do you Dx DVT?
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Ultrasound-Venous Doppler
Contrast venography |
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Name some symptoms of PE
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dyspnea
tachypnea chest pain low grade fever hypotension unexplained syncope |
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how do you Dx PE?
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ABG
ECG-rule out MI Chest x-ray |
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MC test for PE?
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V/Q scan
others: MRI Echo Pulm angiography |
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Name 2 thrombolytics used to treat PE
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Alteplase
Streptokinase However, they are not the drug of choice due to their side effects |
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what drug do you start at the same time as Heparin?
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Warfarin
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what is the MOA of warfarin?
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inhibits synthesis of vit-K dependent proteins
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what labs do you do if you suspect DVT/PE?
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PTT, PT, CBC, Platelets, D-dimer
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How do you treat HIT?
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Argatroban
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You've confirmed DVT or PE, how do you treat?
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Heparin:
70 IU/KG bolus; then 15 IU/KG/hr always use actual weight LMWH: Enoxaparin 1mg/kg sc q12 if CrCl is <30 then q24 |
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when you overlap argatroban with warfarin, what should your INR be?
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4-6 because it will be falsely elevated, therefore pt is really around 2-3
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what is the dose of warfarin when overlapping UFH or LMWH?
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Start on first day at 5mg
Adjust to INR 2-3 Treat for 3 months If Pt has been previously on warfarin, start at 7.5mg |
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what do you monitor when dosing warfarin?
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INR, not PT
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what is the loading dose of Heparin for a CVA?
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There is no loading dose
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how do you reverse heparin?
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Protamine
1mg neutralizes about 100 U of heparin |
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Can you reverse lovenox?
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No
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what's more expensive UFH or Lovenox?
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Lovenox
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what are the 3 LMWH's?
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Dalteparin
Enoxaparin Tinzaparin |
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what do you monitor with Lovenox?
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PTT
Platelets SCr CBC H/H |
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what are the benefits of using Lovenox?
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less monitoring
Longer half-life Reduced incidence of HIT |
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Do you dose adjust Lovenox according to PTT?
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No, but you still need to do PTT to check for bleeding
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What is a side effect of all heparins including lovenox?
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Osteopenia
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what is the dosing for long-term DVT prophylaxis
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Lovenox 40mg sc Q24 or 30mg sc Q24h if CrCl <30
Heparin 5,000 IU sc q8h No renal adjustment needed |
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what agent is mostly used for long term DVT prophylaxis?
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Warfarin
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how long should you prophylax?
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First episode:
Secondary cause-3 months Idiopathic- 6 months Cancer, Protein C or S def.- 6 months Second episode: Life long or filter placement |
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what are the risk factors for bleeding complications?
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TRRAASH
Thrombocytopenia Renal failure Recent surgery Age >65 y/o ASA use Stroke H/o GI bleed |
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where do most bleeding complications happen?
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GI and UTI
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what is the most serious complication of using anticoagulants?
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Bleeding
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what is a complication of protamine use?
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Hypotension, must be infused slowly over 10-15 minutes
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your pt has an INR of 5, his bleeding is not life threatening, what do you do?
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Hold the warfarin
Give Vit K 5-10mg PO If bleeding is life threatening, give it SC |
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when do you give Vit K IV?
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NEVER, causes hypotension
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your patient is started on heparin, his platelets drop consistently, what do you do?
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he has HIT and heparin should be replaced with argatroban
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what is an alternative to argatroban for treating HIT?
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Angiomax (bivalirudin)
Like argatroban, it is a direct thrombin inhibitor |
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what are complications of anticoagulants?
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BSHH
Bleeding Skin necrosis HIT Hypersensitivity |
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which drugs increase PT
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Androgens(birth control pill)
Thyroid hormones |
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which drugs decrease PT?
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Inducers:
BCGRP Barbituates Carbamazapine Griseolfulvin Rifampin Phenytoin Increased risk of clotting, therefore increase dose by 25% |
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Name some alternative/herbal drugs that have anticoagulant properties
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Vitamin E
Fish Oils ASA Ginko Biloba Garlic |
