3 main risk factors for VTE (Virchow’s triad)
- Hypercoagulability
- Vascular damage
- Circulatory stasis
When to start VTE treatment?
Positive with imaging/ compression ultrasound
When to give VTE prophylaxis?
High risk for VTE (4 points or more)
Above or below knee is more associated with embolism?
Above knee
Plasmin degrades fibrin mesh, giving _____ as the by-product
D-dimer
What scoring system is used to diagnose VTE/ PE?
Wells score
Duration of tx for apixaban
Acute phase: first 7 days
Early maintenance: day 8-90
Duration of tx for rivaroxaban
Acute phase: first 21 days
Early maintenance: day 22-90
Risk factors for VTE
- Age 75 or more
- Prior VTE Hx (highest risk during first 180 days aft VTE)
- Blood stasis
- Vascular injury
- Hypercoagulability
Is thrombus likely to embolise in the calf?
No
Oral Anticoagulants used in Tx for VTE
- Warfarin
- Rivaroxaban, Apixaban
- Dabigatran
- Edoxaban
Thrombolytic agents used in tx for ACS/ AIS
- Alteplase
- Tenecteplase
IV Anticoagulants used in Tx for VTE
- UFH
- LMWH (enoxaparin)
(DTI: Bivalirudin)
Why does LMWH have less inhibitory activity against UFH?
LMWH has less than 18 saccharide units hence cannot catalyse (anti-thrombin-mediated) inactivation of thrombin
Warfarin inhibits the production of clotting factors __________
II, VII, IX, X
Which DOACs require initial parenteral tx?
Dabigatran & Edoxaban
Do not use Edoxaban when CrCl > _____
95 mL/min
