TLDR
PT
A venous thromboembolism that winds up in the main, segmental, or subsegmental branches of the pulmonary artery
What is a pulmonary embolism?
This drug class inactivates the circulating and clot bound factor that merges the extrinsic and intrinsic pathway
indicated for prophylaxis and treatment of VTE, Afib to prevent thromboembolism, and ischemic heart disease
What are Direct Factor Xa inhibitors?
Rivaroxaban (aka Xarelto) or Apixaban (Eliquis)
Do not need continuous monitoring via labs like with warfarin
Most patients require anticoagulation following VTE for this amount of time at a minimum. Coincidentally, this is the same amount of time that couples on a famous TLC show about fiancés have to get married.
What is 3 months (90 days)?
TT
What is Thrombin Time?
A venous thromboembolism that ends up in the popliteal, femoral, or iliac veins
What is a deep venous thrombosis?
This drug inhibits clot formation by directly preventing fibrin production
indicated for VTE prophylaxis, stroke prevention in patients with Afib, and in ischemic heart disease.
What is an oral Direct Thrombin Inhibitor?
Dabigatran (aka Pradaxa)
should not be given during pregnancy or to patients with renal insufficiency
Consider indefinite anticoagulation to prevent DVT in patients in patients who meet this criteria. Hint: Georgia's pattern of losses to the Alabama crimson tide
What is recurrent DVT?
(what is back to back (recurrent) losses in the Benz :(? )
VWF
What is Von Willebrand Factor?
A common treatment provided to postmenopausal women or transgender patients and can provoke a hyper-coagulable state that puts patients at greater risk for VTE.
What is estrogen therapy?
Vitamin K antagonist that depletes vitamin k and results in decreased production of clotting factors dependent on vitamin k. Will need to monitor INR once every 4 weeks if stable and once weekly if unstable.
indicated for prophylaxis of VTE, in patients with abnormal renal function
What is Warfarin?
Adverse effects: fatal bleeding, acute kidney injury, hypersensitivity, calciphylaxis, skin necrosis/gangrene, atheroemboli
Positive: reversible agents available
Consider indefinite anticoagulation for DVT in a patient with this criteria. Hint: the reason Forrest runs across the country
What is an unprovoked DVT?
(DVT that has no identifiable cause)
aPPT
A common risk factor for VTE among patients in nursing homes, in hospitals, on bed rest, or on long airplane trips.
What is reduced mobility?
Anticoagulant that binds directly to antithrombin and induces conformational change that increases rate of inactivation of coagulation factors by antithrombin
indicated for use during pregnancy (does not cross placenta), patients with liver disease and coagulopathies, and patients with cancer
What is low molecular weight heparin?
administered subcutaneously and is good option for patients who cannot take medication orally
Consider indefinite anticoagulation for DVT in a patient with this criteria. Hint: Lay's: “Betcha can't eat just one.”
What is DVT provoked with minor, persistent, irreversible, or multiple risk factors?
INR
What is International Normalized Ratio?
2 major risk factors incurred by many women. Icon Serena Williams experienced both, resulting in a postponement of her return to the top of the game.
What is pregnancy and cesarian section?
This drug is an antithrombin III-mediated selective inhibitor of factor Xa. It is an alternative to LMW heparin when contraindicated in patients with heparin-induced-thrombocytopenia
Indicated for VTE prophylaxis, DVT/PE treatment, HIT treatment
What is Fondaparinux?
contraindicated in patients with renal insufficiency
Consider placement of IVC filter in this patient with a DVT. HINT: This principle applies to anticoagulation therapy, which should have been applied to the creation of Carmel apple flavored Oreos. Just because you can doesn't mean you should.
What is contraindications to anticoagulation?
Active hemorrhage, platelet count <50,000 mL, prior intracerebral hemorrhage