Term
| #1 time to get VTE in pregnancy |
|
Definition
|
|
Term
| in pregnancy what percent are DVT and PEs of all VTE |
|
Definition
|
|
Term
| where are the majority of the DVTs in pregnancy |
|
Definition
|
|
Term
|
Definition
|
|
Term
| rate of VTE in GYN sx without PPX |
|
Definition
|
|
Term
| rate of mortality from PE |
|
Definition
|
|
Term
| rate of PEs occurring post-op of all PEs |
|
Definition
|
|
Term
| rate of VTE in cancer patients |
|
Definition
|
|
Term
| when do most PE occur in cancer patients |
|
Definition
|
|
Term
| how much to SCDs lower VTE |
|
Definition
|
|
Term
| which is better SCDs or lovenox |
|
Definition
|
|
Term
| categories in CAPRINI scoring, risk of VTE and management |
|
Definition
very low - 0.5% - none
low (1 pt) - 2% - SCDs
medium (2 pts) - 15% - SCDs or Rx
high (3-4pt) - 30% - SCDs + Rx
higest (5+ pts) - 70% - SCDs + Rx |
|
|
Term
| things that are 1pt in CAPRINI - 18 |
|
Definition
| 40-60yo, leg swelling, vericose veins, BMI >25, minor surgery, sepsis/CHF/major sx/lung dx/preg within 1mo, MI, bedrest, COPD, IBD, HRT/OCP, hx of stillbirtjh/IUGR/RPL/pre-e |
|
|
Term
| things that are 2pt in CAPRINI - 7 |
|
Definition
| 60-75yo, cancer, sx >45min, bedrest >72h, cast <1mo ago, central line, arthroscopic surgery |
|
|
Term
| things that are 3pt in CAPRINI - 8 |
|
Definition
| 75yo, history of VTE, factor V, anti-cardiolipin, prothrombin mutation, lupus-anticoagulant, thrombophilias, elevated homocystine |
|
|
Term
| things that are 5pt in CAPRINI - 5 |
|
Definition
| CVa/trauma/LE fx/spine inj in past 1mo, major LE arthro |
|
|
Term
|
Definition
| X to Xa - need 1Xa, VIIa / PT to T - need Xa / fibrinogen to fibrin - need thrombin |
|
|
Term
| what is the intrinsic side of the clotting cascade |
|
Definition
|
|
Term
| what is the extrinsic side of the clotting cascade |
|
Definition
|
|
Term
| which anticoagulants alter antithrombin and Xa |
|
Definition
| lovenox, heparin, fondaparinox |
|
|
Term
| which anticoagulants only alter Xa |
|
Definition
|
|
Term
|
Definition
| direct thrombin inhibitor |
|
|
Term
|
Definition
| K dependent clotting factor inhibitor - II, VII, X, IX |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| which blood thinners are renally cleared |
|
Definition
| lovenox, fondaparunox, rivaroxaban, dabigatraban |
|
|
Term
| time to stop lovenox pre-op and start post-op |
|
Definition
|
|
Term
| time to stop heparin pre-op and start post-op |
|
Definition
|
|
Term
| time to stop fondaparanox pre-op |
|
Definition
|
|
Term
| time to stop rivaroxaban pre-op and start post-op |
|
Definition
|
|
Term
| time to stop dabigatroban pre-op and start post-op |
|
Definition
|
|
Term
| time to stop warfarin pre op and restart post op |
|
Definition
|
|
Term
|
Definition
| only on therapeutic dosing, Xa 0.5-1.3 4h after dose |
|
|
Term
|
Definition
| PTT 1.5-2.5 6h after dose |
|
|
Term
| how is fondaparanox monitored |
|
Definition
| you can do Xa but it doesn't correlate well (better than lovenox though in obese patients) |
|
|
Term
| how is rivaroxaban monitered |
|
Definition
| elevated PT/PTT if suprapubic, you can monitor Xa but it dosent mean anything |
|
|
Term
| how is dabigatroban monitored |
|
Definition
| it isn't, but the PTT will be elevated |
|
|
Term
| how is warfarin monitored |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how is fondapranox reversed |
|
Definition
| it isn't, but you can try factor VII |
|
|
Term
| how is rivaroxaban reversed |
|
Definition
| it isn't, even dialysis dosent work well, try prothrombin concentrates |
|
|
Term
| how is dabigatroban reversed |
|
Definition
|
|
Term
|
Definition
| vitamin K, FFP in emergency |
|
|
Term
| contraindications to lovenox |
|
Definition
|
|
Term
| contraindications to fondaparanox |
|
Definition
|
|
Term
| contraindications to dabigratbam |
|
Definition
|
|
Term
| contraindications to warfarin |
|
Definition
| pregnancy, but not breastfeeding |
|
|
Term
| complications of lovenox and heparin |
|
Definition
HIT lovenox 0.2%, heparin 2-6%
osteoporosis, 2-3% vertebral fracture in 1y |
|
|
Term
| complications of warfarin |
|
Definition
| warfarin syndrome, clots in 1st 72h of initiation (inhibits protein C/S) |
|
|
Term
| complications of dabigatroban |
|
Definition
| brain and GI bleeds in >75yo |
|
|
Term
| which anticoagulant is best for afib and mechanical valves |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| when starting heparin and in 7-14d |
|
|
Term
| when to stop heparin for HIT |
|
Definition
| PLT <150 or 50%+ decrease |
|
|
Term
|
Definition
1 - 2-3d onset, self limited
2 - autoimmune, VTE risk |
|
|
Term
| when someone gets HIT what do you switch to |
|
Definition
|
|
Term
| dosing lovenox - therapeutic vs ppx |
|
Definition
|
|
Term
| heparin dosing in pregnancy |
|
Definition
5000 BID 1T
7500 BID 2T
10000 BID 3T |
|
|
Term
| heparin therapeutic dosing |
|
Definition
| 80U/kg load then 18 u/kg/h IV .. OR.. 222 U/kg load then 240 U/kg BID SQ |
|
|
Term
| dosing fondaparunox therapeutic and PPX |
|
Definition
| therapeutic 5-10mg/d weight based, PPX 2.5mg BID |
|
|
Term
| benefit of using lovenox and heparin together |
|
Definition
| for high high risk surgical group, 4x VTE reduction |
|
|
Term
| when to stop ASA before surgery |
|
Definition
minor surgery - continue it
major in high risk patient - continue it
major in low risk patient - dc 7-10d |
|
|
Term
| when to stop Plavix before surgery |
|
Definition
|
|
Term
| when to stop prasugrel before surgery and restart |
|
Definition
|
|
Term
| when to stop tricagrelor before surgery |
|
Definition
|
|
Term
| when to stop apixaban before surgery |
|
Definition
| 1d low risk, 2d mod-high risk |
|
|
Term
|
Definition
| embolism <2mo ago, high risk thrombophilia, AFIB with CHAD 2 of 5-6, any valve, CVA/TIA <6mo ago |
|
|
Term
| what to bridge with - heart valve |
|
Definition
|
|
Term
| what to bridge with - AFIB |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how long to delay surgery after a stent is placed, what if you have to do surgery |
|
Definition
| 6mo, if not must continue their antiplatelet |
|
|
Term
| when do you transition from lovenox to heparin in pregnancy |
|
Definition
|
|
Term
| when do you stop lovenox before CD/IOL |
|
Definition
|
|
Term
| what do you do if a patient is so high risk they need ppx during labor |
|
Definition
|
|
Term
| how long does it take lovenox and heparing to loose their bleeding risk |
|
Definition
| 4h heparin, 12h ppx lovenox, 24h therapeutic lovenox |
|
|
Term
| when do you restart vte ppx after epidural and without |
|
Definition
without - 4-6h
with - 12-24h |
|
|
Term
| pregnancy ppx - history of VTE after non-recurring risk factor (Trauma) |
|
Definition
| no ante ppx, consider PP ppx |
|
|
Term
| pregnancy ppx - history of vte in pregnancy or on OCPs |
|
Definition
|
|
Term
| pregnancy ppx - history of vte idiopathic |
|
Definition
| consider ante ppx, yes pp ppx |
|
|
Term
| pregnancy ppx - history of 2+ vte before |
|
Definition
| therapeutic or ppx ante, therapeutic pp |
|
|
Term
| fetal complicaitons of vte in pregnancy - 4 |
|
Definition
| loss, pre-e, iugr, abruption |
|
|
Term
| criteria for vte ppx after cd |
|
Definition
| 1 major and 2 minor or two major |
|
|
Term
| major criteria vte ppx after cd - 9 |
|
Definition
| immobility antepartum 1+wk, pph, prior vte, pre-e with iugr, thrombophilia, SLE, heart disease, sickle cell, transfusion, infection |
|
|
Term
| minor criteria vte ppx after cd - 6 |
|
Definition
| BMI >30, PPH, smoking >10/d, iugr <25%, C/S deficiency, pre-e |
|
|
Term
| 3 types of diagnosis of DVT and their effectiveness |
|
Definition
d-diner - 95% NPV when >500
duplex - >95% s/s
contrast venography - gold standard |
|
|
Term
|
Definition
| sinus tachycardia, R axis deviation, RBBB, prominent S waves in lead 2, Q waves in lead 3, T waves in lead 3 |
|
|
Term
|
Definition
| paO2 low, paCO2 low, AAG >20 |
|
|
Term
| diagnostic flow of DVT/PE |
|
Definition
| dopplers (skip if no leg sx) --> CXR --> if findings get CT if not get VQ --> VQ non-diagnostic get CT |
|
|
Term
| complications of PE 2 and incidence |
|
Definition
| pulmonary hypertension 5%, post thrombotic syndrome 30% |
|
|
Term
| prevention of post thrombotic syndrome |
|
Definition
| initiate compression stockings 1mo post DVT and keep for 1y |
|
|
Term
| signs of bad outcome for PE |
|
Definition
| hypoxemia, hypocapnia with O2 <95% |
|
|
Term
| indications for IVC filter - 3 |
|
Definition
| anticoagulation contraindicated, recurrent VTE despite anticoagulation, unstable venous thrombosis |
|
|
Term
| indications for pulmonary embolectomy - 2 |
|
Definition
| massive PE, hemodynamic instability |
|
|
Term
| how long to treat with therapeutic after PE |
|
Definition
reversible cause - 6mo
idiopathic - 6mo
thrombophilia/malignancy - 1y to life
recurrent event - 1y to life |
|
|
Term
| incidence of thrombophilia in pregnancy |
|
Definition
|
|
Term
| thrombophilia is associated with __%of all pregnancy related deaths |
|
Definition
|
|
Term
| indications to test for thrombophilia - 3 |
|
Definition
| history of VTE, family member with thrombophilia, family member wity VTE <50yo |
|
|
Term
| incidence of APAS in patients with a history of VTE |
|
Definition
|
|
Term
| incidence of APAS in pre-e patients |
|
Definition
|
|
Term
| incidence of APAS in healthy women without symptoms |
|
Definition
|
|
Term
| diagnosis of APAS - lab - 3 |
|
Definition
| 2 occasions 12wk apart need 1 - lupus anticoagulant, anticardiolipin Ab (>99%ile), anti-B2-glycoprotein 1 (>99%ile) |
|
|
Term
| diagnosis of APAS - clinical - 3 |
|
Definition
| need 1 - fetal death >10wk, pre-e/uteroplacental insufficiency <34wk, 3+ unexplained SAB <10wk |
|
|
Term
| define primary and secondary APAS |
|
Definition
primary - no other autoimmune disorder
secondary - other autoimmune disorder |
|
|
Term
| pregnancy APAS PPX - history of clot |
|
Definition
| therapeutic or PPX heparin until 6wk PP, ASA benefit unclear, until 6wk PP |
|
|
Term
| pregnancy APAS PPX - no history of clot |
|
Definition
| prophylactic heparin and ASA until 6wk PP |
|
|
Term
| pregnancy APAS PPX - history of RPL/stillbirth |
|
Definition
| prophylactic heparin and ASA until 6wk PP |
|
|
Term
|
Definition
|
|
Term
| complications APAS pregnancy - 6 |
|
Definition
| RPL, fetal loss, IUGR 33%, pre-e, GHTN 5.5x, PTD |
|
|
Term
| risk of thrombi APAS in pregnancy |
|
Definition
| 25% risk of recurrent thrombi without anticoagulation 5-12% risk ante partum 25% risk PP |
|
|
Term
| most likely locations of arterial clots in pregnancy in APAS - 4 |
|
Definition
| subclavian, digital, brachial, retinal |
|
|
Term
| #1 location of venous clot in pregnancy |
|
Definition
|
|
Term
| high risk thrombophilias - 4 |
|
Definition
| homo V, homo PT, PT/V, AT3 |
|
|
Term
| low risk thrombophilias - 4 |
|
Definition
|
|
Term
| which thrombophilias can you test for in pregnancy - 2 |
|
Definition
|
|
Term
| which thrombophilias cant you test for in pregnancy - 3 |
|
Definition
| C, S, AT3 - but C you can test for in the 2T should be <30% and 3T <24% but these numbers are not accurate and should not be for official diagnosis |
|
|
Term
| thrombophilias with a <1T prevalence - |
|
Definition
| V homo, PT homo, PT/V, C, S, AT3 |
|
|
Term
| prevalence of heterozygote factor V |
|
Definition
|
|
Term
| prevalence of heterozygote PT deficiency |
|
Definition
|
|
Term
| thrombophilias with a <1% risk of first VTE in pregnancy - 4 |
|
Definition
| V hetero, PT hetero, C, S |
|
|
Term
| thrombophilias with a 1-5% risk of first VTE in pregnancy - |
|
Definition
|
|
Term
| risk of first VTE in pregnancy with AT3 |
|
Definition
|
|
Term
| risk of recurrent VTE during pregnancy factor V homo/heterozygote |
|
Definition
|
|
Term
| risk of recurrent VTE during pregnancy AT3 homo/heterozygote |
|
Definition
|
|
Term
| risk of recurrent VTE in pregnancy V/PT |
|
Definition
|
|
Term
| risk of recurrent vte in pregnancy protein C/C |
|
Definition
|
|
Term
| risk of recurrent VTE in pregnancy in AT3 |
|
Definition
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - factor V heterozygote |
|
Definition
clot - PPX/PPX
none - xxx/consider if FHX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - factor V homozygote |
|
Definition
clot - TX/TX
none - PPX/PPX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - PT heterozygote |
|
Definition
clot - PPX/PPX
none - xxx/consider if FHX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - PT homozygote |
|
Definition
clot - TX/TX
none - PPX/PPX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - PT/V |
|
Definition
clot - TX/TX
none - PPX/PPX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - protein C |
|
Definition
clot - PPX/PPX
none - xxx/consider if FHX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - protein S |
|
Definition
clot - PPX/PPX
none - xxx/consider if FHX |
|
|
Term
| anticoagulation in pregnancy with and without history of VTE - AT3 |
|
Definition
clot - TX/TX
none - PPX/PPX |
|
|
