Thrombophilias
So you think you have a DVT...
Postpartum Care
Anticoagulants
Miscellaneous Facts
100
Which of the following coagulation factors is increased in pregnancy: Von Willebrand factor, Factor V or Protein C.
What is Von Willebrand factor (increased risk for delayed PPH).
100
Virchow's Triad (pregnancy-style).
What is hypercoagulability, increased venous stasis (decreased mobility), decreased venous outflow (compression of IVC by uterus)? Also: maternal obesity, multifetal gestation, AMA, diabetes.
100
Risk of VTE post-cesarean section in all patients.
What is 1/1000.
100
Anticoagulant not recommend in pregnancy but is safe for breastfeeding.
What is warfarin.
100
Virchow's Triad.
What is hypercoagulability, venous stasis, endothelial injury?
200
25 yo G1P0 with Factor V Leiden (heterozygote) and no previous VTE--is anticoagulation indicated?
What is NO (low risk thrombophilias (Factor V Leiden, Prothrombin, Protein C or S deficiency) with no history of VTE can be monitor expectantly.
200
Location most likely have a DVT in pregnancy.
What is LLE?
200
Indications for post-partum anticoagulation.
What is low risk thrombophilia with history of VTE, any high risk thrombophilia, any history of VTE.
200
Mechanism of action of warfarin.
What is inhibits vitamin-K dependent synthesis of clotting factors II, VII, IX, X, prot C, S and Z.
200
Percentage of cases of VTE in pregnancy that are recurrent events.
What is 15-25%?
300
25 yo G1P0 with Factor V Leiden (heterozygote) and single previous VTE--is anticoagulation indicated?
What is MAYBE-- can do prophylactic (40mg lovenox QD) or intermediate (40mg lovenox BID) or surveillance.
300
Initial diagnostic test for suspected VTE.
What is compression ultrasonography?
300
INR target in postpartum female.
What is 2.0-3.0 (remember to bridge!)
300
How long should a laboring patient wait after receiving a dose of LMWH before epidural placement.
What is 10-12 hrs if on prophylactic dose and 24 hours if on therapeutic dose.
300
Indications for IVC filter placement in pregnancy.
What is DVT 2-4 wks prior to delivery, recurrent VTE despite therapeutic coagulation, condition in which anticoagulation is contraindicated.
400
25 yo G1P0 with Factor V Leiden (homozygote) and no previous VTE--is anticoagulation indicated?
What is YES. Prophylactic dose LMWH or UFH indicated.
400
The approximate prevalence of VTE in pregnancy.
What is 1/1600.
400
The increased risk of VTE in a factor V leiden heterozygote who you mistakenly prescribe OCPs to.
What is 35-99 fold (28.5/10000 from 5.7/10000).
400
Ideal anticoagulant for patients with a history of HIT. **Daily double**: mechanism of action.
What is fondaparinux, a synthetic pentasaccharide factor Xa inhibitor, thought to form high affinity binding site for antithrombin III (anticoagulant), making the anticoagulant effect 1000-fold. In contrast to heparin does not inhibit thrombin.
400
Amount of estimated fetal exposure to radiation from CXR vs CT chest.
What is 0.02 rad vs 1 rad.
500
25 yo G1P0 with two VTEs after femur fracture on lifetime warfarin (no known coagulopathy)--is anticoagulation indicated?
What is YES. Should have therapeutic-dose LMWH (lovenox 1mg/kg q12h).
500
Below what D-Dimer level is a DVT unlikely in pregnancy?
What is <500.
500
Major risk factors for post-cesarean section DVT/PE (per AACP).
What is - bed rest >1 wk antepartum. - PPH >1000cc - pre-eclampsia with fetal growth restriction. - infection - thrombophilia.
500
Resumption of LMWH on a patient with Factor V Leiden (homozygous) mutation who was on anticoagulation during pregnancy.
What is 4-6 hours after vaginal delivery and 10-12 hours after cesarean delivery.
500
Signs of warfarin use in first trimester in fetus.
What is nasal hypoplasia, scoliosis, calcifications in vertebral column, femur and heel bone, asbrachydactyly, congential heart defects, agenesis of the corpus callosum, LBW and developmental delays.
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