Risk Factors & Diagnosis
The gold standard for PE diagnosis.
What is chest CT?
Name one non-pharmacologic VTE prophylaxis for hospitalized patients.
What is graduated compression socks, intermittent pneumatic compression devices (SCDs, VFPs), and ambulation?
The drug class of Pradaxa and how it's mechanism differs from others from the same class.
What is a DOAC and direct thrombin inhibitor?
Target INR for patients on warfarin for PE.
What is 2-3?
This anticoagulant requires INR monitoring and is reversed with vitamin K.
What is warfarin?
Define provoked VTE.
What is a VTE caused by an identifiable risk factor.
Examples: active cancer, stasis due to long car ride, and trauma
Padua score ≥___ indicates high risk in medical inpatients.
What is 4?
These two oral anticoagulants require at least 5 days of parenteral anticoagulation before they can be started for VTE treatment. Hint: no overlap
What is dabigatran and edoxaban?
This lab test is monitored to titrate unfractionated heparin therapy to goal therapeutic anticoagulation.
What is aPTT or anti-Xa?
This DOAC must be taken with food.
What is rivaroxaban?
Lab test commonly used to rule out VTE in low-risk patients.
What is a D-dimer?
Name one contraindication to pharmacologic VTE prophylaxis.
What is active bleeding, risk outweighs benefit, high bleed risk?
Anticoagulant that is preferred in pregnant patients.
What is enoxaparin?
Two things you should monitor (besides labs) in a patient receiving anticoagulation therapy.
What is symptoms of VTE, unusual bleeding, bruising, black tarry stools, coffee ground emesis, adherence, alcohol avoidance, drug interactions?
This direct thrombin inhibitor is dosed lower in critically ill patients, and it falsely elevates INR values.
What is argatroban?
Definition of a massive PE.
What is PE hemodynamic instability - sustained hypotension (SBP <90 mmHg) or need for vasopressors?
A hospitalized patient with no ongoing indications for VTE prophylaxis was started on enoxaparin while inpatient. Upon discharge, should enoxaparin prophylaxis be continued at home or discontinued?
What is discontinue?
The PREFERRED therapeutic dosing, route, and frequency for enoxaparin.
What is 1 mg/kg SubQ Q12H?
What labs should be checked at baseline for all patients starting anticoagulation?
What is CBC, renal function, hepatic function?
This DOAC is preferred over others in its class because it can be used in patients with Child-Pugh A or B liver disease and in those with lower creatinine clearance or on hemodialysis.
What is apixaban?
Name Virchow's triad.
What is venous stasis, endothelial injury, and hypercoagulability?
The preferred VTE prophylaxis agent, dosing, and frequency for hospitalized, non-surgical patient on hemodialysis.
Heparin 5K SubQ BID-TID
This DOAC should not be used if CrCl >95 mL/min due to reduced efficacy.
What is edoxaban?
This is given to patients on a DOAC (excluding dabigatran) and have a bleed to "reverse" them.
What is 4F-PCC (four-factor prothrombin complex concentrate)?
This thrombolytic agent is given as 100 mg IV over 2 hours for massive PE.
What is alteplase?