VTE Pathophysiology

What is called the body’s physiological response for the prevention of bleeding?

Hemostasis

What organ produces most of the body’s clotting factors?

Liver

What is categorized as blood clot in a deep vein, usually the leg?

Deep Venous Thrombosis

What is categorized as a blood clot in the lung?

Pulmonary Embolism

What is categorized as blood clot in a vein?

Venous Thromboembolism

What is defined as a wandering blood clot? 

Embolus 

What is often the result of a piece of a DVT clot traveling to the pulmonary artery?

Pulmonary Embolism

What is called the theory that describes the three broad categories of factors that are thought to contribute to thrombosis?

Virchow’s Triad

At what age does the risk of VTE double with each decade?

50

What is defined as the overproduction of red blood cells? 

Polycythemia Vera

What is defined as enlarged or twisted veins?

Varicose Veins

What would have Pain behind the knee upon flexing the foot?

Homan’s Sign

What is:

-The most commonly used test for DVT
-A Noninvasive test that measures the rate and direction of blood flow while allowing visualization of veins and thrombi

Duplex Ultrasonography

The absence of blood flow in a duplex ultrasonography indicates what? 

Obstruction

What is:

-The Gold Standard test for DVT, being the most accurate and reliable
-Uses a contrast dye to inject into a vein in the foot helping to identify and locate thrombi in the veins of the affected extremity
-EXPENSIVE AS SHIT

Venography

Symptoms of PE are specific

False

Symptoms of PE are nonspecific

True

What is:

-Used to help rule out the presence of blood clots
-A lab blood test

D-Dimer Test

What usually means that there is little to no chance a patient has a blood clot?

Negative D-Dimer

What is the normal range for D-Dimer?

<250

What is:

-The most commonly used test for PE
-Measures the distribution of air and blood flow in the lungs

Ventilation Perfusion Scan

What are usually released into the bloodstream of fibrin degradation products and can be objectively measured? 

D-Dimers

What is:

-Expensive
-Uses contrast dyes to inject into the pulmonary artery to visualize the pulmonary artery
-Is associated with significant risk of mortality

Pulmonary Angiography

What is:

-The golden standard test for PE
-A Computed Tomography to obtain and image of the pulmonary arteries to see if a blood clot is present
-Less Invasive

CT Pulmonary Angiography (CAT scan)

What heart valve disorder is defined as blood flow backups?

Regurgitation

What heart valve disorder is defined as blood flow unable to go forward?

Stenosis

What has a high risk of thrombosis and strokes? 

Heart Valve Replacement 

After valve replacement, patients usually require what?

Anticoagulants

What’s the brand name for Enoxaparin?

Lovenox

What’s the generic name for Lovenox?

Enoxaparin

What’s the brand name for Dalteparin? 

Fragmin

What’s the generic name for Fragmin?

Dalteparin

Enoxaparin (Lovenox) and Daleparin (Fragmin) Are both categorized as what?

Low Molecular Weight Heparins

What’s the brand name for Rivaroxaban?

Xarelto

What’s the generic for Xarelto? 

Rivaroxaban

What’s the brand name for Dabigatran?

Pradaxa

What’s the generic name for Pradaxa?

Dabigatran

What’s the brand name for Apixiban?

Eliquis

What’s the generic name for Eliquis? 

Apixiban

What’s the brand for Edoxaban?

Savaysa

What’s the generic for Savaysa?

Edoxaban

What’s the brand for Warfarin?

Coumadin

What’s the generic for Coumadin?

Warfarin

Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Apixiban (Eliquis), Edoxaban (Savaysa) Are all what type of anticoagulants?

Direct Oral Anticoagulants

Bivalirudin and Argatroban are both what?

Direct Thrombin Inhibitors

What measures the biologic activity of blood clotting factors 2, 7, and 10 and is also the measurement of blood clotting time?

Prothrombin Time

What’s the normal range for PT? 

12 - 13 seconds

What is the preferred way to monitor warfarin therapy? 

INR

What is the normal range in patients not taking warfarin?

0.8 - 1.0

The lower the INR, the longer it takes for blood to clot

False

The higher the INR, the longer it takes for blood to clot

True

What is the Goal of INR for patients with DVT or PE? 

2.0 - 3.0

What is:

-Commonly used to monitor the treatment effects of heparin therapy
-Measures the biologic activity of blood clotting factors 12, 11, 9 , 8, 10, 5, 2

aPTT

What is the normal range for patients not taking any heparin or anticoagulants for aPTT?

30-40 seconds

What is the therapeutic aPTT goal for a patient taking heparin?

1.5 - 2.6 times the normal value

What:

-Measures both heparin and LMWH therapy levels
-Can be used to measure the efficacy of some of the newer anticoagulants

Anti-Factor Xa Level Monitoring 

What is the Therapeutic range for LMWH?

0.5 - 1.2

What is the therapeutic range for Heparin?

0.3 - 0.7

If the Patient’s Anti Xa Heparin levels is <0.15, what’s the most appropriate action?

Bolus 30 units/kg and increase by 4 units/kg/hr

If the patient’s Anti Xa Heparin levels are 0.15 - 0.29, what’s the most appropriate action? 

Bolus 15 units/kg and increase by 2 units/kg/hr

If the patient’s Anti Xa Heparin levels are 0.3 - 0.7, what’s the most appropriate action?

No Change

If the patient’s Anti Xa Heparin levels is 0.71 - 1, what’s the most appropriate action?

Decrease by 2 units/kg/hr

If the patient’s Anti Xa Heparin levels is > 1, what’s the most appropriate action?

Call MD, stop infusion for 1 hr then decrease by 3 units/kg/hr

What is defined as DVT that happens in a patient that has a known risk factor? 

Provoked DVT

What is defined as DVT that happens in a patient with no known risk factor?

Unprovoked DVT

What is defined as using non pharmacologic therapy or pharmacologic therapy to prevent the develop of a blood clot in patients that have risk factors?

VTE Prophylaxis

What is defined as Patients now having a blood clot, and will be using non-pharmacologic therapy or pharmacologic therapy to prevent further complications from the active blood clot?

VTE Treatment

What is defined as Low platelet count that happens due to a reaction from Heparin? 

Heparin Inducted Thrombocytopenia