Shared Flashcard Set

Details

Boards - VTE
OBGYN Qualifying exam
138
Other
Post-Graduate
06/26/2020

Additional Other Flashcards

 


 

Cards

Term
#1 time to get VTE in pregnancy
Definition
within 1wk PP
Term
in pregnancy what percent are DVT and PEs of all VTE
Definition
80% DVT, 20% PE
Term
where are the majority of the DVTs in pregnancy
Definition
LLE
Term
rate of VTE in pregnancy
Definition
1/1600, 5x
Term
rate of VTE in GYN sx without PPX
Definition
15-40%
Term
rate of mortality from PE
Definition
11%
Term
rate of PEs occurring post-op of all PEs
Definition
1/3
Term
rate of VTE in cancer patients
Definition
40%
Term
when do most PE occur in cancer patients
Definition
>POD7 76%
Term
how much to SCDs lower VTE
Definition
3x
Term
which is better SCDs or lovenox
Definition
same
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
clotting cascade
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
XII, XI, IX
Term
what is the extrinsic side of the clotting cascade
Definition
VII
Term
which anticoagulants alter antithrombin and Xa
Definition
lovenox, heparin, fondaparinox
Term
which anticoagulants only alter Xa
Definition
riveroaxban
Term
MOA of dabigatran
Definition
direct thrombin inhibitor
Term
MOA warfarin
Definition
K dependent clotting factor inhibitor - II, VII, X, IX
Term
t1/2 lovenox
Definition
24h
Term
T1/2 heparin
Definition
1-2h
Term
T1/2 fondaparenox
Definition
13h
Term
T1/2 riveroxaban
Definition
5-13h
Term
T1/2 dagigatran
Definition
8-15h
Term
which blood thinners are renally cleared
Definition
lovenox, fondaparunox, rivaroxaban, dabigatraban
Term
time to stop lovenox pre-op and start post-op
Definition
12-24h, 6-8h
Term
time to stop heparin pre-op and start post-op
Definition
2h, 8-12h
Term
time to stop fondaparanox pre-op
Definition
2-4d
Term
time to stop rivaroxaban pre-op and start post-op
Definition
24-48h, 6-10h
Term
time to stop dabigatroban pre-op and start post-op
Definition
24-48h, 1-4h
Term
time to stop warfarin pre op and restart post op
Definition
4h, immediate
Term
how is lovenox monitored
Definition
only on therapeutic dosing, Xa 0.5-1.3 4h after dose
Term
low is heparin monitored
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
INR 2-3
Term
how is lovenox reversed
Definition
protamine sulfate
Term
how is heparin reversed
Definition
protamine sulfate
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
idarucizumab
Term
how is warfarin reversed
Definition
vitamin K, FFP in emergency
Term
contraindications to lovenox
Definition
GFR <30
Term
contraindications to fondaparanox
Definition
renal dysfunction
Term
contraindications to dabigratbam
Definition
renal dysfunction
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
dabigatroben
Term
risk of VTE in HIT
Definition
50% in 3d
Term
PLT monitoring for HIT
Definition
when starting heparin and in 7-14d
Term
when to stop heparin for HIT
Definition
PLT <150 or 50%+ decrease
Term
2 types of HIT
Definition
1 - 2-3d onset, self limited
2 - autoimmune, VTE risk
Term
when someone gets HIT what do you switch to
Definition
fondaparuinox
Term
dosing lovenox - therapeutic vs ppx
Definition
1mg/kg BID, 40mg BID
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
5d
Term
when to stop prasugrel before surgery and restart
Definition
7d, 12-24h
Term
when to stop tricagrelor before surgery
Definition
3-5d
Term
when to stop apixaban before surgery
Definition
1d low risk, 2d mod-high risk
Term
who needs bridging - 5
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
lovenox
Term
what to bridge with - AFIB
Definition
anoxaparin
Term
when to start bridging
Definition
5d before surgery
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
36wk
Term
when do you stop lovenox before CD/IOL
Definition
24-36h
Term
what do you do if a patient is so high risk they need ppx during labor
Definition
heparin
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
ante and pp ppx
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
EKG signs of PE - 6
Definition
sinus tachycardia, R axis deviation, RBBB, prominent S waves in lead 2, Q waves in lead 3, T waves in lead 3
Term
ABG findings in PE - 3
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
1:1000
Term
thrombophilia is associated with __%of all pregnancy related deaths
Definition
9
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
2%
Term
incidence of APAS in pre-e patients
Definition
1/5
Term
incidence of APAS in healthy women without symptoms
Definition
5%
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
APFT APAS
Definition
GS and APFT
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
70% LE
Term
high risk thrombophilias - 4
Definition
homo V, homo PT, PT/V, AT3
Term
low risk thrombophilias - 4
Definition
hetero V, hetero PT C, S
Term
which thrombophilias can you test for in pregnancy - 2
Definition
V, PT
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
1-15%
Term
prevalence of heterozygote PT deficiency
Definition
2-5%
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
V homo, PT homo, PT/V
Term
risk of first VTE in pregnancy with AT3
Definition
3-7%
Term
risk of recurrent VTE during pregnancy factor V homo/heterozygote
Definition
homo - 10%
hetero - 17%
Term
risk of recurrent VTE during pregnancy AT3 homo/heterozygote
Definition
homo - 10%
hetero - 17%
Term
risk of recurrent VTE in pregnancy V/PT
Definition
20%
Term
risk of recurrent vte in pregnancy protein C/C
Definition
approx. 15%
Term
risk of recurrent VTE in pregnancy in AT3
Definition
>40%
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
Supporting users have an ad free experience!