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8 Cards in this Set
- Front
- Back
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Why is VTE important?
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1. Very common (DVT)
2. Leading cause of maternal death associated with childbirth (PE) 3. Causes more deaths in NA than breast cancer+AIDS+highway fatalities (PE) 4. Most common and preventable cause of hospital death (PE) 5. 60,000 patients hospitalized each year (DVT) 6. 1/3 of patients with DVT will develop post-thrombotic syndrome |
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What is Virchow's Triad?
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Endothelial Damage
Venous Stasis Hypercoagulability |
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What are VTE provoking factors? (11)
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Surgery
Trauma Cancer Prolonged immobility Obesity Smoking Medical Conditions - Antiphospholipid antibody disorders (SLE, etc) Oral contraceptives Pregnancy Hormone therapy Catheters |
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What is risk of recurrence of provoked VTE vs. unprovoked VTE?
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5%/yr vs >12%/yr
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What are hereditary causes of VTE? (5)
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Factor V Leiden
Prothrombin 20210 Antithrombin deficiency Protein C deficiency Protein S deficiency |
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Diagnosis of VTE: Clinical, Lab Tests
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1. Clinical: History+physical+clinical tool
2. Lab Tests: D-dimers (high sensitivity, low specificity therefore use when have low pretest probability to rule out), Doppler U/S, Venogram (gold standard but rarely done), CXR (not reliable), V/Q scans, CT |
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Treatment of VTE: rationale, options, adverse effects, treatment of warfarin overdose, indications for thromboembolic therapy
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1. Rationale: 50% untreated DVTs extend, 50-70% untreated DVTs cause PE, 10-30% untreated PEs are fatal, prevent recurrence, prevent post-thrombotic syndrome
2. Options: LMWH, warfarin, oral anticoagulants (dabigatran, rivaroxaban), TPA 3. Adverse effects: LMWH (bleeding, heparin induced thrombocytopenia, osteoporosis), Warfarin (bleeding, birth defects) 4. Treatment of Warfarin Overdose: Adjust dose or oral vit K (if not bleeding), prothrombin complex concentrate or FFP+IV vit K (if bleeding) 5. Indications for thromboembolic therapy: Life or limb threatening DVT or PE |
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What is the normal treatment regimen for VTE? Why?
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LMWH immediately, transition to Warfarin for 6mo to indefinitely
Warfarin takes several days to reach therapeutic concentrations in body |
