List the two types of Venous Thromboembolisms (VTE)

What is a VTE?

List factors that could contribute to a VTE

Which kind of thrombosis is a formation of a clot in a deep vein of the body/

Veins located where are the most commonly affected by DVT

What are the most common veins w/in the leg that are affected by DVT?

Which distal veins in the leg can be affected by DVT?

Blockage of a main artery of the lung or one of its branches is known as _______

PE most commonly results from __________ that breaks off and migrates to the lungs

What is a common symptoms of a PE?

T/F: Incidence of VTE triples each decade over 45

Describe the pathophysiology of a VTE

What are the parts of Virchow's Triad?

Risk factors of VTE

List examples of hypercoagulable states:

List examples of venous stasis that could increase risk of blood clot

List examples of vascular injury that could increase risk of blood clot

List examples of medication that could increase risk of blood clot

T/F: Most DVT pts have no symptoms. If they do have symptoms, typically the s/sx are bilateral and non-specific.

List symptoms of DVT

List the signs of DVT

T/F: When assessing for a DVT, we use the symptoms more than signs (signs are not super specific and we don't usually look for those)

T/F: D-dimer is a diagnostic blood test used to evaluate for VTE. It is a screening tool only (not used for diagnosis)

D-dimer <500ng/mL =

D-dimer >500 ng/mL =

D-dimer has high ___________(sensitivity/specificity) and low ___________(sensitivity/specificity)

T/F: D-dimer levels are decreased in acute thrombosis

__________ is a degradation product of a fibrin clot used as a screening tool for VTE

T/F: A higher score on the Well's criteria for DVT = higher risk for DVT

What is the most common way to diagnose a DVT?

What does Duplex Ultrasonography ("dopplers") do in regards to DVT?

What is the gold standard (but last line) way to diagnose DVT?

Why is venography last line for DVT diagnosis?

List the complications of DVT

Describe post-thrombotic syndrome

Symptoms of post-thrombotic syndrome:

T/F: Many pts w/ PE may present w/ symptomatic DVT

S/Sx of PE depend on what?

Symptoms of PE:

Signs of PE

What is the most common tool for diagnosing PE?

How does a CT work?

T/F: CT iodine-contrast agent is less likely to cause anaphylaxis by dye (compared to venography)

What is the second line diagnosis tool for PE?

How does Ventilation/Perfusion (VQ) work?

What is the third line diagnosis tool for PE?

What is the gold standard (but last line) diagnostic tool for PE?

Why is Pulmonary angiography last line for PE diagnosis?

T/F: Diagnosis of PE is associated w/ significant morbidity and mortality

T/F: Sudden death is the first symptom in ~25% of pts who have a PE

Goals of therapy for DVT:

Goals of therapy for PE

Orthopedic pts need to b on what additional therapy?

List the initial VTE therapy options:

How long should warfarin therapy overlap w/ either LMWH/UFH/Fondaparinux?

Which pts can use the injectable products LMWH or Fondaparinux?

Why must therapy with warfarin and a parenteral anticoagulant be overlapped?

Duration of therapy for first provoked VTE

Duration of therapy for idiopathic VTE

Duration of therapy for 2 or more VTE

Duration of therapy for VTE w/ active cancer

Duration of therapy for:

• Anti-phospholipid antibodies
• Factor V leiden
• Prothrombin mutation

Non-pharm therapy for VTE

Indications for UFH therapy

MOA of UFH:

Administration of UFH

UFH t_1/2 :

UFH elimination

T/F: Prophylaxis UFH should be monitored w/ aPTT

LD of IV UFH for VTE treatment:

Max LD of IV UFH

Initial maintenance dose of IV UFH for VTE treatment:

Subsequent maintenance dose of IV UFH for VTE treatment

Goal aPTT for IV UFH for VTE treatment

Goal anti-factor Xa for IV UFH for VTE treatment

Lab monitoring for IV UFH for VTE treatment

Which monitoring test for UFH is sensitive to changes in the intrinsic and common coagulation pathways?

How is the aPTT test performed?

T/F: aPTT can vary based on the reagent used to test the sample

When would aPTT be measured?

AE of UFH

UFH monitoring:

UFH antidote:

Additional UFH AEs

SQ UFH monitoring:

T/F: Renal dose adjustment is required for renal insufficiency

UFH pregnancy category

T/F: We cannot use UFH in pregnant pts, but we can use it in children

Hepatic insufficiency means there will be enhanced anticogulant effects. Do we need hepatic dose adjustment for UFH?

Which LMWH is most commonly used for prophylaxis, VTE treatment, and VTE treatment in cancer and pregnant patients?

MOA of LMWH

Elimination of LMWHs:

Which LMWHs are used as prevention of VTE in cases of acute medical illness?

Monitoring for LMWH in prevention (acute medical illness)

Normal dose and freq of enoxaparin

Dose and freq for enoxaparin if CrCl <30 mL/min

What will always need to be monitored with LMWH?

How often should CBC be measured with LMWH?

Under what circumstances should anti-Xa levels be measured for a pt on LMWH?

Anti-Xa goal level:

If a pt who is on LMWH is determined to need anti-Xa monitoring, when would you need to monitor?

Antidote for LMWH

BBW for LMWH

Major and minor AE for LMWH

T/F: If pt previously experienced HIT, you can not use LMWH.

T/F: There is less incidence of HIT/long term effects with LMWH compared to UFH

T/F: LMWH is safe to use in pregnant pts, but not pediatrics

If a pt has severe rheumatoid arthritis in their hands, would LMWH be a good recommendation for them?

Advantages of LMWH over UFH

Fondaparinux brand

Rivaroxaban brand

Apixaban brand

Edoxaban brand

Betrixaban brand

List the factor Xa inhibitors

Which factor Xa inhibitors are first line?

T/F: Fondaparinux is used for the treatment and prevention of VTE and is weight based dosing

Antidote for fondaparinux

T/F: Fondaparinux cannot be used for management of HIT

Fondaparinux is contraindicated in:

Describe the dosing for Rivaroxaban in the treatment of VTE (initial and after initial treatment)

Rivaroxaban monitoring

Why must rivaroxaban be taken with food?

Rivaroxaban/apixaban antidote

Rivaroxaban is contraindicated in:

Rivaroxaban/apixaban drug interactions

Describe the dosing for Apixaban in the treatment of VTE (initial and after initial treatment)

T/F: Rivaroxaban and Apixaban are contraindicated in pts with CrCl <30 mL/min

Describe treatment of VTE with Edoxaban

Antidote for edoxaban

Betrixaban is used for:

Direct thrombin inhibitors are used primarily for:

Dabigatran brand

Dabigatran MOA

T/F: If a patient is starting dabigatran, they would need to be on a parenteral anticoagulant for 5-10d, THEN can start dabigatran on day 6

Unique AE of pradaxa

Antidote of Dabigatran

Warfarin brand

T/F: Rivaroxaban, Apixaban, dabigatron, and warfarin are all first line

Warfarin dosing:

Warfarin is metabolized by:

Warfarin dose changes should not be made more frequently than:

Goal for INR for warfarin

INR <2 means

INR >3 means

How often is INR monitored?

Why should you give a pt one strength of warfarin (even if the dose varies throughout the week)?

AE of warfarin

Management of supratherapeutic warfarin: INR above therapeutic range but < 4.5; no significant bleeding

Management of supratherapeutic warfarin: INR bw 4.5-10; no significant bleeding

Management of supratherapeutic warfarin: INR >10; no significant bleeding

Management of supratherapeutic warfarin with major bleed

If a pt is having a scheduled surgery, warfarin should be stopped for _____ d before the surgery, and resumed ~_______ after surgery?

T/F: If a pt is having a scheduled surgery and stops their warfarin, they do not need a bridge therapy since it is only a temporary pause in the warfarin

Warfarin pregnancy category

T/F: Warfarin can be used in peds, pts with renal insufficiency, and pts with hepatic insufficiency

Examples of drugs warfarin interacts with

Warfarin important pt counseling:

Anticoagulants to use in pregancy:

Anticoagulants to use in peds

Anticoagulants to use in cancer pts