What are three primary components that may cause development of a thrombus?
100
Pain upon acute dorciflexion
What is positive Homan's sign?
100
Agents that prevent clot formation and extension, but do not break the existing clot
What are anticoagulants (warfarin, heparin, LMWH, fondaparinux)
100
Enoxaparin dose for VTE Prophylaxis (hip or knee replacement):
What is 30mg SC Q 12 H (if CrCl<30 ml/min - 30 mg SC daily)
100
When shoud we re-check INR upon initiating the therapy with warfarin?
Every 1-3 days
200
A portion of the thrombus which breaks off and lodges in pulmonary artery or one of its branches
What is PE?
200
By-product of thrombin activation of fibrinogen to fibrin that is used for diagnosis of DVT
What is D-dimer?
200
Warfarin and concurrent metronidazole (or clarithromycin or amiodarone or cimetidine or antifungals)
Increase in INR and required warfarin dose decrease
200
Heparin dose for VTE prophylaxis:
5,000 units SC Q 8-12 H
200
When should we re-check INR after a dosing change in patients on chronic therapy?
-After one INR within the therapeutic range on a stable dose, re-check in 1-2 weeks;
- After two INRs within the therapeutic range (at same dose), re-check in 4 weeks
-All stable patients should have INR checked at minimum every 4 weeks
300
Factor that converts Prothrombin (II) to Thrombin (IIa)
What is factor Xa
300
Test for venous flow patterns: absense of sound indicates partial obstruction or obstruction of venous flow
What is Duplex Ultrasound/Doppler ultrasound
300
Initiation of therapy - heparin bolus dose (?), followed by infusion (?)
Bolus: 80 units/kg IV bolus ( range 80-100 units, max 10,000 units) followed by infusion: (18 units/kg/h, max 2,300 units/h - use actula weight)
300
Patients in highr risk of bleeding and requiring prophylaxis of VTE:
-Older patients
- Surgery (especially hip replacement and knee replacement_
- Prolonged immobility
- Heart failure
Previous VTE
Cancer
300
What is recommended warfarin dose change for patients wiht sub-therapeutic range?
5-10%
400
Factor that converts Fibrinogen to Fibrin
What is Thrombin(IIa)?
400
Normal INR (not on warfarin therapy)
What is 0.8-1.2
400
Agent used to reverse heparin-induced hemorrhage:
What is protamine sulfate?
400
Fondaparinux dose for VTE prophylaxis:
2.5 mg SC daily
400
How would INR change in response to high alcohol intake the night before the check?
INR will be increased.
500
Deep vein above the knee
What is popliteal vein?
500
Time used for assessment of response to heparin therapy
What is aPTT
500
Dose of enoxaparine used for "bridge" therapy:
What is enoxaparine 1mg/kg SC Q 12H - same dose as DVT treatment
500
Does patient admitted for pneumonia (anticipated 2 day stay currently walking halls) require prophylaxis of VTE?
No, patient is still mobile.
500
What are the monitoring parameters of VTE therapy?
Baseline:
-aPTT, CBC (platelets, Hgb, Hct), UA, stool guaiac, Scr)
Ongoing:
-signs of bleeding/bruising
-every 1-3 days CBC