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Venous Thromboembolism and Heparin Induced Thrombocytopenia - Coggle…
Venous Thromboembolism and Heparin Induced Thrombocytopenia
VTE importance
Preventable cause of hospital complication
25% with risk factors will develop DVT
1/3rd of those with DVT will develop PE
Pathophysiology
Virchows triad
Perturbation
Injury to the vascular endothelium
Alterations to blood coagubility
Risk factors
Venous stasis
Immobility
Long travel
Varicose veins
Endothelial injury
Indwelling devices
Surgery
Trauma
Burns
Hypercoagulability
Malignancy
Pregnancy
Obesity
Smoking
Medical conditions
Classification of PE
Massive
Hypotension SBP<90
Pulselessness
Persistent profound bradycardia <40bpm
Submassive
RV dysfunction
Myocardial necrosis
Investigation
CTPA
Echocardiography
RV dilation 25%
McConnells sign
Management
European society of cardiology
Supportive
Haemodynamic
Respiratory
Anticoagulation
IV Heparin
Large polysacceride
ATIII
APTT monitoring
Clareance by reticuloendothelial system
Primary repurfusion
Thrombolysis
Surgical embolectomy
Percutaneous catheter directed treatmetn
PEITHO trial
Submassive PE reduced mortilaty with tenectoplase however increased intracranial haemorrhage
Prevention
Non pharmacological
Mobilisation
Hydration
Stockings
Pharmacological
LMWH
Heparin BD dosing similar efficacy
NOACs
dabigatran IIa
Rivaroxeban 10a