Risks
When should you assess a patient's risk for thrombosis?
Prior to surgery
True or False: SERMS are associated with an increased risk of VTE?
True
How do SCDs prevent thromboses?
Reduce venous stasis and produce endogenous fibrinolytic molecules
What type of prophylaxis is recommended for patients who have a low risk of VTE ?
Mechanical- Sequential compression device > graduated compression stockings
What medication can be used in the perioperative period if a patient cannot tolerate UFH or LMWH?
Fondaparinaux
How long are patients at risk for VTE after surgery?
4 weeks
How is unfractionated heparin reversed?
Protamine sulfate
True
How should patients with moderate risk of VTE and a high risk of bleeding be managed?
Mechanical prophylaxis
What are the advantages of LMWH compared to UFH?
Longer half-life & greater bioavailability
Less frequent dosing
Lower risk of HIT
How many days after surgery do patients usually present with VTE?
6-15 days
Name a direct factor Xa inhibitor
Rivaroxiban or Apixaban
Why are SCDs preferred to Compression stockings?
SCD efficacy is similar to pharmacoprophylaxis
Lower risk of skin complications
How should patients with a moderate risk of VTE and low risk of bleeding be managed?
Either pharmaco- or mechanical prophylaxis
True or false: Transfusion rates are higher in those receiving UFH compared to SCDs.
False
What are the two most common inherited thrombophilia mutations found in patients with a new thrombosis?
Factor V Leiden & G20210A
What is the mechanism of action of Fondaparineux?
Indirect factor Xa inhibitor
When should mechanical prophylaxis be used in the perioperative period?
Placed prior to surgery and continued until fully ambulatory
What type of pharmacoprophylaxis is preferred in patients with renal dysfunction?
Low dose unfractionated heparin
What is the risk of thrombosis if a patients Caprini score is in the low risk category?
1.5%
Moderate risk- 3% & High risk- 6%
LMWH has more anti-factor Xa activity and less antithrombin activity
4-6 weeks
How should patients with GYN Malignancies be managed?
Mechanical & pharmacoprophylaxis followed by 4 months of pharmacoprophylaxis
A study was quoted that reviewed risks of bleeding in patients receiving UFH. What was the rate of reoperation for bleeding complications in this study?
1% (compared to 0.7% in those without medication)