Term
|
Definition
- venous stasis
- intimal injury
- hypercoaguability
Have to have these 3 to get a clot |
|
|
Term
| With DVT, the thrombus usually forms on the __ __. |
|
Definition
|
|
Term
| Short term course of DVT: |
|
Definition
| - risk of DVT> acute thrombophlebitis> resolution and recanalization 6-12 weeks |
|
|
Term
| Long term history of DVT, __ __ __ may occur. In severe cases __ __ __ and __ __ __ may occur which are __ threatening. |
|
Definition
- post phlebitic syndrom
- phlegmasia cerulea dolens
- phlegmasia cerulea albens
- limb threatening |
|
|
Term
| Phlegmasia cerulea dolens is aka __ __ or __ __. It is leg threatAening b/c the pressure in the __ side is increasing so you also get __ occlusion. |
|
Definition
- milk leg or white leg
- arterial
- arterial occlusion |
|
|
Term
|
Definition
- obesity
- sedentary lifestyle
- smoking and COPD
- BCPs/HRT
- Malignancy
- trauma
- Orthopaedic surgery
- Abdominopelvic surgery
- Operative time greater than 2 hours
- HITTS
- Hypercoagulable states |
|
|
Term
|
Definition
- Polycythemia, blood is thick, lots of RBCs
- Antiphospholipid antibodies
- Protein C and S deficiency
- Myeloma
- Antithrombin III deficiency
- Dysfibrinoginemia
- Plasmingen disorders |
|
|
Term
| DVT patient presentation: |
|
Definition
- unilateral edema
- pain
- distended veins
- calor
- discoloration (red/purple)
- calf tenderness (Homan's sign) |
|
|
Term
| Only 20% of pts with DVT have __ __. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
- duplex venous u/s with color flow doppler- BEST CHOICE
- Impedance plethysmography
- Venography
- Ventilation/perfusion scan (V/Q scan)
- Pulmonary angiogram
- Contrasted CT- most precise best for PE |
|
|
Term
| A ventilation perfusion scan (V/Q scan) is a __ test. ___ can give false positives for DVT. |
|
Definition
|
|
Term
|
Definition
- prevent propagation of clot and PE
- Acute- severe cases: hospitalization, bedrest, anticoagulation |
|
|
Term
| HEPARIN DOES NOT DISSOLVE A CLOT, IT ONLY PREVENT NEW CLOTS FROM FORMING. KNOW THIS. |
|
Definition
|
|
Term
Acute - superficial or infrageniculate cases
can consider outpt. therapy with low molecular weight heparin therapy
Still require immobilization and intermediate term anticoagulation (minimum 6 wk.) |
|
Definition
|
|
Term
| minimum anticoagulant therapy length for DVT; |
|
Definition
|
|
Term
|
Definition
- anticoagulations: warfarin
- leg elevation
- avoid prolonged sitting/standing |
|
|
Term
| Do NOT use __ __ with chronic DVT b/c clots can break off and go north. |
|
Definition
|
|
Term
|
Definition
- Heparin
- LMWH
- Coumadin (Warfarin)
- Alternative: Hirudin |
|
|
Term
|
Definition
- Bolus
- Continuous drip
- Half life
- Monitoring
- Antidote |
|
|
Term
| HITTS is __ __ __ while on heparin. It is aka __ __ __. |
|
Definition
- unexpected arterial thrombosis
- white clot syndrome
HIT IS IMMUNE MEDIATED, IF DROPS BELOW 100,000 OR 50% BELOW WHAT THEIR PLATELETS WERE WHEN THEY STARTED. |
|
|
Term
| Heparin Induced Thrombocytopenia is an __ __ __ __ to the ___ __ __ __ complex. The onset is usually __ to __ __ after initiating heparin, but can be earlier or later. It can be with or without __ complications. The dx is __. Any type of heparin or route of administration can lead to HIT. |
|
Definition
- immune-mediated allergic reaction
- heparin-platelet factor 4 complex
- 5 to 14 days
- with or without thrombotic complications
- clinical |
|
|
Term
|
Definition
Thrombosis
0.4%–2.2%
Thrombocytopenia
2%–3%
Antibody formation
7.8%–51% |
|
|
Term
|
Definition
| - PF-4 binds the surface of platelet following activation> complexes of heparin and PF-4 form> IgG binds heparin/PF-4 complexes> IgG/heparin/PF-4 complexes activates via the Fc receptor> Fc stimulation leads to generation of procoagulant rich particles |
|
|
Term
|
Definition
Timing of thrombocytopenia
Typically 5 to 14 days after initiation of heparin, except in patients with recent heparin exposure
Earlier onset of thrombocytopenia with heparin
re-exposure
Onset may be delayed
Degree of thrombocytopenia
Decrease from baseline of 30% to 50%
Very low platelet counts (<15,000/mcL) rare
Other causes of thrombocytopenia excluded
Presence of thrombosis or other characteristic sequelae
If HIT is suspected, discontinue heparin IMMEDIATELY: Do not wait for results of lab tests
Initiate alternative anticoagulant |
|
|
Term
| Contraindications to Anticoagulation: |
|
Definition
- active hemorrhage
- recent head trauma/spinal surgery
- recent stroke (CVA)
- pregnancy (relative)
- CNS tumor
- AAA
- AVM
- uncontrolled HTN
- bleeding disorder |
|
|
Term
| Conditions in which you should think twice about adminstering anticoagulation, but you still can if benefit outweighs risk: |
|
Definition
- liver disease
- fall risk
- recent surgery
- mural thrombus
- diabetic retinopathy |
|
|
Term
| Interventional DVT treatment: |
|
Definition
- Inferior vena cava interruption
- Thrombolysis
- Thrombectomy |
|
|
Term
| Post Phlebitic Syndrome is __ __ __ in which there is __ __ __ leading to __ __. Manifestations include __ __, __ __ __, __ __, and __. |
|
Definition
- chronic venous stasis
- valve cusp contraction leading to venous reflux
- exercise intolerance
- venous stasis ulceration
- venous gangrene
- phlegmasia |
|
|
Term
|
Definition
- ambulatory to surgery
- SCD's prior to anessthesia induction
- Pre-op heparin in high risk pts
- Ambulate early post-op
- Atraumatic surgical technique
- Post-op LMWH and SCDs |
|
|
Term
| Thrombectomys have a high incidence of __ __ and __ __ __. An __ __ should be done at the same time to change the flow. |
|
Definition
- recurrent thrombosis
- post phlebitic syndrome
- AV fistula |
|
|
Term
| Venous bypass has a high incidence of __ and may allow time for ___. This is usually for __ __ patients or for __ ___ __ __. |
|
Definition
- failure
- collateralization
- severely symptomatic patients
- limb threatening venous congestion |
|
|
Term
| Thrombolysis is a __ __ __, but you must correct the underlying cause. This usually requires __ __ __. It can be done in conjuction with an __ __. It offers __ __ of symptoms and __ incidence of post phlebitic syndrome. |
|
Definition
- catheter directed infusion
- long term anticoagulation
- AV fistula
- immediate relief
- less |
|
|
Term
| Angioplasty and stenting have __ __ failure rates and are usually for __ __ __. This may allow time for __ __. |
|
Definition
- high early failure rate
- severely compromised limbs
- collateral development |
|
|
Term
| 3 types of vena caval interruptions: |
|
Definition
- caval filters
- caval clips
- caval ligation
These don’t prevent clots or DVT, just prevent PE from big clots. |
|
|
Term
|
Definition
- venous valve injury
- incompetant perforating veins
- pain
- throbbing
- edema
- venous stasis
- dermatitis
- venous ulceration
- phlegmasia
- venous gangrene
chronic venous stasis
- valve cusp contraction leading to venous reflux
- exercise intolerance |
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