• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/14

Click to flip

14 Cards in this Set

  • Front
  • Back
Venous Thromboembolism (VTE)

definition
disease that involves the development of DVT and/or PE
Pulmonary Embolism
a thrombus or foreign substance from the systemic circulation that lodges in the pulmonary artery or its branches

complete or partial occlusion of pulmonary blood flow
DVT
thrombus that forms most commonly in the politeal or femoral veins, veins fo the calf, or upper leg
VTE presentation
PE
dyspnea, cough, hemoptysis, tachypnea, tachycardia, pleuritic chest pain, diaphoresis, and overwhelming anxiety

DVT
pain, tenderness, edema, erythema of affected extremity
VTE

pathophys
Venous thrombi form where areas of flow are slow - near valve cusp pocket of calves or thigh.

Factors that can → thrombus
1) Trauma to vessel → release of tissue factor → activation of coagulation cascade
2) immobility
3) hypercoagulability
VTE

Risk factors
Age > 40
prolonged immobility
surgery, trauma, malignancy
pregnancy
previous VTE
CHF, Stroke, aMI, indwelling catheter
Estrogen therapy
Obesity
Inflammatory bowel dz
VTE

IV UFH Guidelines
VTE suspected
- baseline APTT, PT, CBC
- check for CIs, order imaging study
- consider 5000 IU IV

VTE confirmed
- rebolus w/ 80IU/kg IV
- maintenance infultion at 18IU/kg
- APTT at 6h
- platelets b/w days 3-5
- start warfarin tx on day 1 5mg
-adjust subsequent dose via INR
- stop heparin after 4-5 days of
combined tx when INR is > 2
- anticoagulate w/warfarin for 3months
- INR 2-3
VTE

LMWH or Fondaparinux Guidelines
VTE suspected
- baseline APTT, PT, CBC
- check for CIs, order imaging study
- consider 5000 IU IV hep or LMWH or
fondaparinux (fond)

VTE confirmed
- give LMWH or fond
- check platelets b/w days 3-5
- start warfarin tx on day 1 5mg
-adjust subsequent dose via INR
- stop after 4-5 days of combined tx
when INR is > 2
- anticoagulate w/warfarin for 3months
- INR 2-3
LMWH and Pentasaccharide

The drugs
dalteparin (Fragmin)

enoxaparin (Lovenox)

tinzaparin (Innohep)

pentasaccharide
fondaparinux (Arixtra)
advantages of LMWH over UFH
LMWH
have fewer interactions w/plasma proteins so have more predictable response

much longer half-life so SC q12-24

lower incidence of osteoporosis and heparin-induced thrombocytopenia (HIT)
VTE

Direct Thrombin Inhibitors - indications
lepirudin (Refludan)
- DVT
- HIT
argatroban
- HIT
- PCI
How long to treat pts w/VTE
single VTE w/reversible, time-limited rfs
- 3-6 months
- ? what time-limited rfs are and don't
particularly care right now
single idiopathic VTE
- 6 months or longer

recurrent VTE or VTE w/cancer
- 12 months to lifetime
Drugs of Choice for noncardioembolic stroke
Aspirin
Clopidogrel
aspirin/dipyridamole

ie antiplatelet tx not anticoag tx
what is best way to prevent stroke in afib?
warfarin to INR of 2-3 is more effective a preventing stroke than aspirin