Pulmonary Embolism and Anticoagulation Review (Video Notes)

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Q: Why is LMWH often preferred over unfractionated heparin?
- A: Predictable effect, fewer bleeding risks, no routine lab monitoring.
- Rationale: Safer and easier to dose.
Q: Most common PE symptom?
- A: Dyspnea.
- Rationale: Sudden shortness of breath is hallmark.
Q: What is the INR therapeutic range for warfarin?
- A: 2-3.
- Rationale: Balances bleeding vs. clot prevention.
Q: Do anticoagulants dissolve clots?
- A: No — only thrombolytics dissolve clots.
- Rationale: Anticoagulants prevent worsening.
Q: Give two examples of Factor Xa inhibitors.
- A: Rivaroxaban (Xarelto), Apixaban (Eliquis).
- Rationale: Newer oral anticoagulants, no INR checks.
Q: Which three factors make up Virchow’s triad?
- A: Venous stasis, hypercoagulability, endothelial injury.
- Rationale: Pathophysiologic basis for most VTE.
Q: First-line VTE prevention for low-risk patients?
- A: Early ambulation.
- Rationale: Keeps blood moving.
Q: What is the antidote for warfarin?
- A: Vitamin K.
- Rationale: Restores clotting factor production.
Q: Where do you look for earliest signs of bleeding with thrombolytics?
- A: Mucous membranes (gums, nose, eyes, ears).
- Rationale: Bleeding often starts in small vessels.
Q: How long is the “initial” anticoagulation phase?
- A: 7 days.
- Rationale: Uses fast-acting agents like heparin.
Q: Name one retroperitoneal bleed sign linked to IVC filters.
- A: Gray Turner’s sign (flank bruising).

Q: CTA with contrast is gold standard for diagnosing what?
- A: Pulmonary embolism.
- Rationale: Shows clot location and size.
- Rationale: Indicates internal bleeding.
Q: What blood test is elevated in PE?
- A: D-dimer.
- Rationale: Detects clot breakdown products.
Q: What four labs should be monitored for all anticoagulants?
- A: Platelets, hemoglobin, hematocrit, kidney function.
- Rationale: Detects bleeding risk and drug clearance ability.
Q: Why monitor kidney function with anticoagulants?
- A: Many are renally cleared; poor function ↑ bleeding risk.
Q: Example of a thrombolytic drug?
- A: tPA or urokinase.
- Rationale: Used to break down clots in emergencies.
Q: Why isn’t warfarin used for immediate clot prevention?
- A: Takes 5{-}10 days to work.
- Rationale: Needs bridging with heparin/LMWH.
Q: Standard UFH prophylaxis dose?
- A: 5{,}000 units subQ every 8 hours.
- Rationale: Prevents clot formation in moderate-risk patients.
Q: Most PEs originate where?
- A: Deep veins of the legs (femoral, iliac).
- Rationale: DVT is the usual source.
Q: Does diet matter with warfarin?
- A: Yes — keep vitamin K intake consistent.
- Rationale: Fluctuations change INR.
Q: What’s the biggest risk of thrombolytic therapy?
- A: Bleeding.
- Rationale: Potent clot breakdown increases bleed risk.
Q: When are IVC filters indicated?
- A: When anticoagulants are contraindicated or ineffective.

Q: Factor Xa inhibitors — INR monitoring needed?
- A: No.
- Rationale: Predictable drug action.
Q: PE signs: dyspnea, hypoxemia, tachypnea, cough, chest pain — which one is most common?
- A: Dyspnea.
- Rationale: Lungs can't oxygenate properly.
Q: In anticoagulation therapy, which phase can last up to 6 months?
- A: Extended phase.
- Rationale: Long-term clot prevention.
Q: How do anticoagulants prevent complications in PE?
- A: Stop clot growth and prevent new clots.
Q: Name one lifestyle factor that makes anticoagulants unsafe.
- A: Contact sports, homelessness, poor med adherence.
Q: HIT stands for what, and why is it serious?
- A: Heparin-induced thrombocytopenia; can cause severe bleeding and clotting.
Q: Give one moderate-risk VTE prophylaxis option.
- A: Lovenox 40 mg daily or UFH 5,000 units q8h.
Q: Warfarin blocks which vitamin K–dependent clotting factors?
- A: II, VII, IX, X, proteins C & S.