Week 5: Pharm Interventions for VTE

anticoagulants

lower risk of future clot, stop growth of present thrombus, does not dissolve a clot but allows body to break it down

systemic thrombolytic therapy

actively break down clots, greater risk of bleeding but used in life threatening conditions

cateter directed thrombolysis

administer thrombolytic agent at site of clot

catheter directed thrombus removal

aspirate or fragment the clot

inferior vena cava filter

used for those with DVT or at risk that cant take anticoagulant, captures clots and limits ability to move around body

what must you confirm before mobilization if they have a VTE

medication class and time/date of first dose

current anticoagulants used

unfractionated heparin, low molecular weight heparins, fondaparinux, vit K antagonist (warfarin), direct acting oral thrombin/xa inhibitors

less than 3 hours since meds affect on mobility

no mobility

3-5 hours since meds affect on mobility

check with med team

more than 5 hours since meds affect on mobility

mobilize

Fondaparinux times since meds affect on mobility

less than 2 hours-none

2-3 hours-check with med team

more than 3 hrs-mobilize

Unfractionated Heparin (UFH) meds affect on mobility

less than 24 hours-none

more than 24 hrs-check

DOAC (direct acting oral anticoagulant) meds affect on mobility

less than 2 hrs-none

2-3 hrs-check

more than 3-mobilize

what else do they take if on warfarin (Coumadin)

LMWH

warfarin therapeutic range

2-3, LMWH is discontinued once here

what do you base mobilization on if they are taking warfarn?

when LMWH was given

if the INR is supratherapeutic, what can happen with mobility

spontaneous bleeding

if INR is 4-5

avoid restrictive exercise, light activity

if INR is over 5

risk of bleeding continues, consult with MD

if INR is over 6

bedrest

risk with anticoagulant therapy

bleeding, bruising, bleeding complications decrease after 6 months, (use HASBLED)

when to stop anticoagulation if using HASBLED

if 4 or more cannot be modified

once meds are in a therapeutic range

mobilize them, applies to both UE and LE, caution with soft tissue due to bleeding

if person has inferior vena cava filter, you need to confirm what 2 things

hemodynamic stability, no bleeding at puncture site

if they cannot be treated with anticoagulation or IVCF

consult with MD, risk vs benefits

benefit of not being treated

mobility decreases effect of bedrest, decrease risk of another VTE, improve function

risk of not being treated

mobilization could lead to increased risk of PE should the LE DVT dislodge when not treated

mobilization if low risk PE/non massive

once it reaches threshold, can be mobilized

massive/high/intermediate risk mobilization

dont mobilize until hemodynamically stable or at low risk

3 things that are considered hemodynamic instability

cardiac arrest (need to be resuscitated), obstructive shock(SBP over 90, vasopressors needed for bp over 90), persistent hypotension (SBP under 90 or systolic drops under 40, more than 15 min)

if there is no improvement in signs of VTE after 1-2 weeks

refer back to med team

if patient develops signs/symptoms of PTS or CTEPH

refer to med team, if PTS they need mechanical compression