Venous Thromboembolism (VTE) Past Paper PDF (1446) (2024-2025)

Venous Thromboembolism VTE Pharmaceutical Practice Department Therapeutic I Course Code: 1804472-04 4th Year Pharmacy Students Semester 2 (1446) (2024-2025) Learning outcome Student should be able to: Unde...

Venous Thromboembolism VTE Pharmaceutical Practice Department Therapeutic I Course Code: 1804472-04 4th Year Pharmacy Students Semester 2 (1446) (2024-2025) Learning outcome Student should be able to: Understand the basic knowledge of pathophysiology of VTE. Identify common vital/labs used in the assessment of VTE. Recognize the common risk factors for developing VTE. Compare and contrast different types of anticoagulation. Develop a therapeutic plan, including monitoring for efficacy and toxicity, for different populations with VTE. Formulate a prevention strategy for different patient population at high risk for DVT consistent with clinical practice guideline. Vascular Disease Veins VTE Coronary IHD & ACS Vascular Arteries Cerebral Disease Peripheral Renal Stroke & TIA Mesenteric Lymphatic Aorta system 3 January 22, 2 025  Pathophysiology of clots 4 January 22, 2 025 Introduction:  Venous thromboembolism (VTE) is a potentially fatal disorder and significant health problem  VTE results from clot formation within the venous circulation and is manifested as: Deep vein thrombosis (DVT) Pulmonary embolism (PE) DVT is rarely fatal, but PE can result in death within minutes of symptom onset, before effective treatment can be given. 5 January 22, 2 025 Risk factors for VTE Virchow’s Triad 6 Annual Review January 22, 2 025 Presentation & Evaluation: Physical Exams Medical Medications History Risk Factors 7 January 22, 2 025  Presentation:  Symptoms  often asymptomatic  Non-specific  resembles other disease states  Objective testing required to confirm diagnosis 8 January 22, 2 025  Clinical Presentation: Presentation: PE Presentation: DVT  Shortness of breath  Unilateral swelling  Tachycardia  Warmth  Tachypnea  Discoloration  Hemoptysis  Calf tenderness  Anxiety  Pain  Dyspnea  + Homans sign  Cough  Chest pain 9 Venous thromboembolism. Pharmacotherapy: A Pathophysiology Approach. 10th edition  Assessment & Diagnosis Diagnosis: DVT Diagnosis: PE  Wells Model can  Wells Model be used to  D-dimer  ECG determine pre-test  Chest X-ray probability of the  Arterial blood gas patient having DVT  CT scan  D-dimer.  Ventilation/perfusion  Doppler scan(V/Q Scan) ultrasound  Pulmonary angiography  Venography 10 Venous thromboembolism. Pharmacotherapy: A Pathophysiology Approach. 10th edition D-Dimer Degradation product of fibrin clot Sensitive elevated in patients with acute thrombosis Not specific can be elevated due to other cuases Trauma, pregnancy, cancer, surgery, infection, inflammation Wells Clinic al M odel for Evaluating the Pre-test Probability of D VT Wells Clinical Model for Evaluating the Pre-test Probability of PE Goals of VTE Treatment:  Preventing thrombus extension and embolization  Reducing recurrence risk  Preventing long-term complications such as the post-thrombotic syndrome and (CTPH)  Decreasing risk of consequences of PE, such as death, pulmonary hypertension, and impaired functional outcomes.  Approaches to the Treatment of VTE Treatment Strategy Anticoagulant Choices Bridging therapy Injectable anticoagulant (UFH, LMWH, or fondaparinux) initiated with warfarin and overlapped for at least 5 days and until a therapeutic INR is achieved (INR 2-3). Then discontinue injectable anticoagulant and continue warfarin for the appropriate duration Switching therapy Injectable anticoagulant (UFH, LMWH, or fondaparinux) for at least 5 days; then stop injectable anticoagulant therapy and initiate dabigatran or edoxaban for the appropriate duration Monotherapy Initiate rivaroxaban or apixaban at higher initial dose and then convert patient to lower dose for the appropriate duration 15  Acute VTE Management Options 16  Parenteral Anticoagulant Drug Name Dose Renal dose Monitoring parameter adjustment Heparin 80 units/kg IV bolus None aPTT or anti-Xa level check 6 (UFH) then continues hrs after initian and every 6 infusion of 18 hrs until therapeutic then units/kg/hr every 24 hrs abd with every dose change Baseline H/H, platelets, PT, Routine CBC, aPTT monitoring Enoxaparin 1mg/kg SC q 12 hrs or CrCl