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21 Cards in this Set

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What are the 3 main risk factors for VTE according to Virchow's Triad?

1. Abnormalities of blood flow


2. hypercoagulability of the blood


3. blood vessel wall damage


Any alterations of these 3 can lead to the blood clotting.

What are the situations that can cause stasis of the blood?

1. reduced mobility (long distance travel, sedentary lifestyle, surgery)


2. venous stasis caused by a tumour, chronic heart failure and fibrillation

What can be the cause of blood vessel wall damage?

- Surgery


- trauma


- venous catheters

What are the other personal risk factors for VTE?

- Increased age above 40


- Family history


- Smoking


- Medications (oestrogen, SERMs, Heparin, alcohol and hypnotics)

What are the symptoms of DVT?

Can be asymptomatic but typically include:


- Unilateral leg swelling


- Pain and tenderness


- erytherma and warmth


- skin discolouration

What are the possible complications of DVT?


(risk to the patient)

- Recurrent DVT


- Post thrombotic syndrome (permanent damage to the venous valves)


- Pulmonary embolism


- DEATH

What are the mechanical prophylaxis options for DVT?

Generally not used alone, mainly to compliment pharmacological prophylaxis


- graduated compression stockings


- Intermittent pnemonic compression (pulsating compression boot)



What is the pharmacological prophylaxis for a low risk situation? including:


-Uncomplicated surgery with no risk factors


- Major general surgery in patients < 40


- Minot surgery <60

No specific measures requires for the prevention of DVT.

What is the pharmacological prophylaxis for a moderate risk situation? including:


- Major general surgery in patients 40-60yrs with no clinical risk factors


- Immobilised medical patients with additional risk factors (e.g cancer, past VTE, heart failure)

Low dose SC heparin q12h or LMWH d


E.g. Enoxaparin Sc 20mg once daily 7-10/7

What is the pharmacological prophylaxis for a high risk situation? including:


- Major general surgery >60yrs


- major general surgery > 40 yrs with a history of cancer and thromboembolism

Low dose SC heparin q12h or LMWH d E.g. Enoxaparin Sc 40mg once daily 7-10/7

What is the pharmacological prophylaxis for orthapedic surgery of the pelvis, hip or lower limb?

LMWH d


E.g. Enoxaparin Sc 40mg once daily 7-10/7

What is the pharmacological prophylaxis for hip fracture, knee or hip replacement and abdominal surgery

Fondaparinux


2.5 mg SC daily

What is the pharmacological prophylaxis for an elective hip or knee replacement?

NOACs: Apixaban 5 mg bd

What are the aims for the treatment of DVT?

The aim is to prevent


- thrombus extension


- pulmonary embolism


- post-thrombotic syndrome


- recurrent VTE

What is the treatment plan for DVT?

Graduated compression stokings for 18 months


Anticoagulant therapy.


e.g. Warfarin 5 mg d for 3 days then adjust to INR

What is the duration of anticoagulant therapy if:


- VTE was provoked by a transient major risk factor


- Unprovoked distal VTE

3 months

What is the duration of anticoagulant therapy if:


- Its the first unprovkked proximal DVt or PE

6 months

What is the duration of anticoagulant therapy if: - its a recurrent unprovoked VTE

Indefinitely

What is the duration of anticoagulant therapy if:


- First VTE pluc cancer, multiple thrombophilias

Indefinitely

What are the symptoms of PE (pulmonary embolism) ?

Common:


- SoB


- palpitations


- dull central chest pain


Less common:


- haemoptysis


- syncope


- fever

What is the treatment of PE?

- Oxygen at high flow rates


- Analgesia for chest pain


- Anticoagulant


e.g. IV heparin (streptokinase IV) then start warfarin