DVT Management
This type of activity is generally encouraged after a DVT
What is regular walking/physical activity?
This injectable anticoagulant is commonly given around surgery to prevent venous thrombosis
What is low-molecular-weight heparin, such as enoxaparin?
Name any indication for warfarin
Possible answers:
- Prophylaxis/treatment of VT/PE
- Prophylaxis/treatment of thromboembolic complications of AFib/cardiac valve replacement
- Reduction in recurrent MI risk
Adverse effects
- Bruising
- Pain (common)
- Bleeding
These oral anticoagulants are now commonly used as first-line treatment for most uncomplicated DVTs and directly target specific clotting factors
What are DOACS?
Maintaining a healthy level of this can reduce the risk of developing another DVT
What is a healthy body weight?
These non-drug measures reduce postoperative venous stasis by promoting blood flow through the legs
What are early mobilisation and intermittent pneumatic compression?
What clotting factors are produced using vitamin K?
(name all of them)
II, VII, IX, X
Why use LMW (low molecular weight) Heparin over regular heparin?
Can be used without monitoring- longer half life, TI isn't as narrow
Can be given subcut rather than IV- can leave hospital
More predictable
Reduced risk of bleeding- interacts less with platelets, von Willebrand factor and endothelial cells
Unlike dabigatran and edoxaban, these two commonly used DOACs can be started immediately in a patient with DVT without an initial course of heparin or LMWH
What are apixaban and rivaroxaban?
Patients recovering from this should avoid this lifestyle behaviour as it can damage blood vessels
What is smoking?
During a long flight, these measures reduce venous stasis; higher-risk travellers may additionally require graduated compression stockings or clinician-prescribed anticoagulation
What are regularly walking, performing calf exercises and avoiding prolonged immobility?
How does Warfarin lead to a reduction in coagulation?
- Competitively inhibits the enzyme activating vit K
- Reduces functional vit K reserves
- Reduces synthesis of certain clotting factors
What's the MOA?
Binds to Antithrombin III, increases its activity- allowing it to inactivate certain clotting factors (IIa, IXa, Xa, XIIa) Mainly X, (not really II like regular heparin)
What is the primary side effect of taking DOACS?
What is an increased risk of bleeding?
This is a non-pharmacological intervention which can improve venous return and reduce symptoms, although it is not routinely recommended solely to prevent recurrent DVT
What are compression stockings?
After a DVT caused by a major temporary risk factor, anticoagulation is generally continued for at least this length of time
What is three months?
What is the name of the enzyme that warfarin inhibits (name or acronym)?
Vitamin K epoxide reductase complex subunit 1 (VKORC1)
Contraindications
Bleeding disorders,
Major trauma
Thrombocytopenia
Severe hypertension
This group of patients is generally not treated with DOACS for DVT because of concerns regarding fetal exposure and safety
Who is a pregnant patient?