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45 Cards in this Set

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  • Back
What is Virchow's Triad?
Venous stasis
Hypercoagulable state
Vessel injury
what % of DVT's are asymptomatic?
50-60%
What conditions contribute to venous stasis?
Immobilizations
CHF, MI, CVA
Varicose veins
Pregnancy
Obesity
what are some causes of vessel injury?
Trauma
Previous DVT
Venous catherization
Fractures
Major surgery
What drug is used to treat a pregnant pt with DVT?
Heparin; don't use LMWH(lovenox)
name some clinical hypercoagulable states
Malignancy
Estrogen use
Pregnancy
When would you use Coumadin when treating pregnant women with DVT?
only in the second or third trimester
name some clotting factor abnormalities
Protein C or S def.
Antithrombin III def.
Activated Protein C
Prothrombin mutations
how do you Dx DVT?
Ultrasound-Venous Doppler
Contrast venography
Name some symptoms of PE
dyspnea
tachypnea
chest pain
low grade fever
hypotension
unexplained syncope
how do you Dx PE?
ABG
ECG-rule out MI
Chest x-ray
MC test for PE?
V/Q scan

others:
MRI
Echo
Pulm angiography
Name 2 thrombolytics used to treat PE
Alteplase
Streptokinase

However, they are not the drug of choice due to their side effects
what drug do you start at the same time as Heparin?
Warfarin
what is the MOA of warfarin?
inhibits synthesis of vit-K dependent proteins
what labs do you do if you suspect DVT/PE?
PTT, PT, CBC, Platelets, D-dimer
How do you treat HIT?
Argatroban
You've confirmed DVT or PE, how do you treat?
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
when you overlap argatroban with warfarin, what should your INR be?
4-6 because it will be falsely elevated, therefore pt is really around 2-3
what is the dose of warfarin when overlapping UFH or LMWH?
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
what do you monitor when dosing warfarin?
INR, not PT
what is the loading dose of Heparin for a CVA?
There is no loading dose
how do you reverse heparin?
Protamine

1mg neutralizes about 100 U of heparin
Can you reverse lovenox?
No
what's more expensive UFH or Lovenox?
Lovenox
what are the 3 LMWH's?
Dalteparin
Enoxaparin
Tinzaparin
what do you monitor with Lovenox?
PTT
Platelets
SCr
CBC
H/H
what are the benefits of using Lovenox?
less monitoring
Longer half-life
Reduced incidence of HIT
Do you dose adjust Lovenox according to PTT?
No, but you still need to do PTT to check for bleeding
What is a side effect of all heparins including lovenox?
Osteopenia
what is the dosing for long-term DVT prophylaxis
Lovenox 40mg sc Q24 or 30mg sc Q24h if CrCl <30

Heparin 5,000 IU sc q8h

No renal adjustment needed
what agent is mostly used for long term DVT prophylaxis?
Warfarin
how long should you prophylax?
First episode:
Secondary cause-3 months
Idiopathic- 6 months
Cancer, Protein C or S def.- 6 months

Second episode: Life long or filter placement
what are the risk factors for bleeding complications?
TRRAASH

Thrombocytopenia
Renal failure
Recent surgery
Age >65 y/o
ASA use
Stroke
H/o GI bleed
where do most bleeding complications happen?
GI and UTI
what is the most serious complication of using anticoagulants?
Bleeding
what is a complication of protamine use?
Hypotension, must be infused slowly over 10-15 minutes
your pt has an INR of 5, his bleeding is not life threatening, what do you do?
Hold the warfarin
Give Vit K 5-10mg PO

If bleeding is life threatening, give it SC
when do you give Vit K IV?
NEVER, causes hypotension
your patient is started on heparin, his platelets drop consistently, what do you do?
he has HIT and heparin should be replaced with argatroban
what is an alternative to argatroban for treating HIT?
Angiomax (bivalirudin)

Like argatroban, it is a direct thrombin inhibitor
what are complications of anticoagulants?
BSHH

Bleeding
Skin necrosis
HIT
Hypersensitivity
which drugs increase PT
Androgens(birth control pill)
Thyroid hormones
which drugs decrease PT?
Inducers:
BCGRP

Barbituates
Carbamazapine
Griseolfulvin
Rifampin
Phenytoin

Increased risk of clotting, therefore increase dose by 25%
Name some alternative/herbal drugs that have anticoagulant properties
Vitamin E
Fish Oils
ASA
Ginko Biloba
Garlic