VTE

Question 1

VTE for personal history of VTE +
inherited thrombiphilia

Answer 1

high dose LMWH once preg test is pos. till 6 weeks PP
or
until back on PO anticoagulant therapy

include haematology expert opinion

use high dose prophylaxis 50-75% of therpeutic dose
anti Xa monitoring

+/- antithrombin replacement during labour or CS

high prophylactic dose for women 50-90kg is 40mg BD of enoxaparin
5000 units of dalteparin BD
4500IU BD of tinzaparin

Question 2

VTE for personal history of VTE + anitiphospholid syndrome

Answer 2

high dose LMWH once preg test is pos. till 6 weeks PP
or
until back on PO anticoagulant therapy

include haematology expert opinion

use high dose prophylaxis 50-75% of therpeutic dose
anti Xa monitoring

+/- antithrombin replacement during labour or CS

high prophylactic dose for women 50-90kg is 40mg BD of enoxaparin
5000 units of dalteparin BD
4500IU BD of tinzaparin

THIS IS VERY HIGH RISK

Question 3

VTE if patient is on long term anticoagulant due to medical condition

Answer 3

stop warfarin once preg test pos , ideally before 6 w of preg

switch to high dose LMWH till delivery then switch back to warfarin

haematology expert option include

high prophylactic dose for women 50-90kg is 40mg BD of enoxaparin
5000 units of dalteparin BD
4500IU BD of tinzaparin

Question 4

VTE FOR

previous VTE (unprovoked) in preg or estrogen related

NO inherited disorders

Answer 4

LMWH prophylactic dose from start of ANC til 6 weeks PP

THIS IS HIGH RISK- use standard dose

Question 5

previous provide VTE ex. related to surgery

no risk of inherited thrombophilia

Answer 5

LMWH trophy dose from 28w till 6 weeks PP

THIS IS INTERMEDIATE RISK

Question 6

Asymptomatic high-risk thrombophilia
what are they and how to manage VTE

Answer 6

-protein C or S deficiency
-those with more than one thrombophilia defect (including
*homozygous factor V Leiden,
*homozygous prothrombin gene mutation
*compound heterozygotes)

no personal hx of VTE

CONSIDER prophylaxis from 28 w , refer to local expert
recommend 6w PN LMWH

THIS IS INTERMEDIATE RISK

Question 7

asymptomatic low risk thrbopholioa
what are they and how to manage

Answer 7

-heterozygotes for factor V Leiden
-heterozygone for prothrombin gene mutation
antiphospholipid antibodies

considered as 1 risk factor for thrombosis in asymptomatic women- calculate risk and give LMWH according to score

PN calculate risk and give according but 6 WEEKS IF SIGNIFICANT FAMILY HX OF VTE

THIS IS LOW RISK

Question 8

points

prev VTE (not provoked)

Answer 8

4

Question 9

points

prev VTE provoked by major surgery

Answer 9

3

Question 10

points

known high risk thrombophilia

Answer 10

3

Question 11

points

medica comorbidites which ones and how many points

Answer 11

3

cancer , heart failure,
active SLE, inflammatory pilyarthsropathy or inflammatory bower disease
nephrotic syndrome
Type 1 DM with nephropathy
sickle cell disease
current IVDU

Question 12

points

fam history of unprovoked or estrogen related VTE in 1st deg relative

Answer 12

1

Question 13

points

known low risk low risk thrombophilia (no VTE)

Answer 13

1

asymptomatic
-heterozygotes for factor V Leiden
-heterozygone for prothrombin gene mutation
antiphospholipid antibodies

Question 14

points

age >35

Answer 14

1

Question 15

points

obesity

Answer 15

1 or 2b

1 if BMI >/=30
2 if BMI > / = 40

Question 16

points

parity > or = 3

Answer 16

1

Question 17

smoker

Answer 17

1

Question 18

gross varicose veins

Answer 18

1

Question 19

PET in current preg

Answer 19

1

Question 20

ART/IVF - antenatal only

Answer 20

1

Question 21

multiple preg

Answer 21

1

Question 22

CS in labour

Answer 22

2

Question 23

elective CS

Answer 23

1

Question 24

mid cavity or rational operative del

Answer 24

1

Question 25

prolonged labour >24h

Answer 25

1

Question 26

PPH over 1L or transfusion

Answer 26

1

Question 27

preterm birth <37w in current preg

Answer 27

1

Question 28

still birth in current preg

Answer 28

1

Question 29

any surgical op in preg or peurperam except repair of perineum immediately eg. appendectomy, PP sterilization

Answer 29

3

Question 30

hyperemesis

Answer 30

3

Question 31

OHSS

Answer 31

4

Question 32

current systemic infection

Answer 32

1

Question 33

immobility , dehydration , long distance travel >/= 4h

Answer 33

1 immobility for >/= 3 days

Question 34

<50kg

Answer 34

20mg enoxapain 2500 dalteparin 3500 tinzaparin

Question 35

50-90kg

Answer 35

40 eno 5000 dalt 4500 tinz

Question 36

91-130kg

Answer 36

60 enox 7500 dal 7000tinz

Question 37

131-170kg

Answer 37

80 enox 10 000 dalt 9000 tinz

Question 38

>170 kg

Answer 38

0.6mg/kg/day enox 75u/kg/day dalt 75 u kg/day tinz

Question 39

very high risk

Answer 39

1.prev VTE on long term PO anticoagulant 2. antithrombin def 3. antiphospholipid syndrome with prev VTE

Question 40

High risk

Answer 40

1. any prev VTE - not a single VTE related to major surgery

Question 41

Intermediate risk

Answer 41

asymptomatic high-risk thrombophilia 1. homozygous facto V 2. homozygous Leiden 3. compound heterozygote 4. Protein C or S deficiency 5. single previous VTE associated with major surgery without thrombophilia, family his or her risk factors

Question 42

low risk

Answer 42

asymptomatic low risk thrombophilia ( heterozygous prothrombin gene mutation or factor V Leiden)