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Thromboembolic Disease - Coggle Diagram
Thromboembolic Disease
Nonthrombotic PE
Septic Emboli
- Seen with R-sided endocarditis
2.Treatment: Antibotics, no need to treat with anticoagulation
Amniotic Fluid Embolism
- Presents within 36 hours post-partum
- Giving birth + DIC [hypoxia and become bleeding from all IV sites]
- Imaging: Nonspecific
4: Supprtive, correct coagulopathy
Air Embolism
- Usually occurs with removal of dialysis line
- Imaging: Look for air in the large vessels
- Tx: IV fluids + oxygen + Left lateral decubitus position in Trendelenburg [locks air in the R ventricle]
Fat Embolism
- Usually post long bone fracture
- PE Symptoms + diffuse petechial rash + fever
- Imaging: Septic emboli w/o cavitation
- Tx: Supportive care; outcome is usually good
Tumor Embolism
- Presents as worsening hypoxia/chest pain & heart failure symptoms with hx of malignancy [GI, breast, lung]
- Imaging: Interlobular septal thickening, micronodules, marked RV dilation but NO pulmonary embolism [NO PE, but see RV dysfunction]. Lymphangitic carcinomatosis is common.
- Tx: Chemotherapy, prognosis is poor. Dx usually made on autopsy.
DVT
Treatment
Proximal clot, Sx, non-modifiable risk factors, and high-dimer warrants treatment. Duration of 3 months for a provoked DVT with transient risk factors. If non-modoifiable, at LEAST 3 months
Pretest Probability
- Risk Factors
- Wells Score
0 = Obtain d- dimer / 1+ or higher - obtain ultrasound
Acute Pulmonary Embolism
Risk Stratification
-
RV Dysfunction
- CTA: Look at septal flattening, increased RV/LV ratio. NOT CLOT BURDEN
- Ultrasound: RV dilation or small LV. Look for McConnel's Sign [RV bouncing up & down like a trampoline]. D-sign: LV forms a D during systole from bowing out & sign of acute or chronic RV pressure overload.
Labs/Biomarkers:
- Troponins
- NT- pro BNP
- Lactate
-
Diagnosis
Wells Criteria
6 -> CTA
2-6 --> D-dimer --> CTA<2 --> PERC rule
Treatment
Low Risk --> Anticoagulation Alone. DOAC's. No need for admission provided they can be safely anticoagulated outpatient
High Risk
- Systemic Thrombolytics is a 1B recommendation and answer in the absence of contraindication
- Catheter based tx are for those with contraindications to lytics or those who fail lytic therapy
Intermediate Risk
- Anticoagulation & Monitoring. Get lovenox & go to the ICU.
- DO NOT do lytics or surgery UNLESS hemodynamic deteroriation
- Duration: Minimum of 3 months. 6 months for unprovoked PE and re-evaluate annually.
PE in Pregnancy
Diagnosis
- If UNLIKELY --> D-dimer
- DVT +/- PE --> Start with LE Ultrasound
- If PE --> CTA of chest [NOT V/Q Scan]
Treatment
- Pre-partum: Lovenox
- Post-partum: If breastfeeding --> LMWH/Lovenox, If not breastfeeding --> DOAC
- IF HIGH RISK --> TPA is first line. If there is a contraindication to TPA, catheter-based interventions/ECMO should be considered.
- DURATION: At least 3 months that includes duration of pregnancy & 6 weeks after birth
