CC Jan 2016 Anticoagulation for Unprovoked DVT

echoecho's version from 2016-01-05 16:55


Question Answer
The American College of Chest Physicians (ACCP) has developed recommendations for the use of anticoagulation in patients with venous thromboembolism (VTE), deep venous thrombosis (DVT), and pulmonary embolism (PE). ACCP uses three definitions of therapy. List these three?1) initial treatment (parenteral anticoagulation, thrombolysis) 2) long term (3-month) therapy (warfarin [Coumadin], low-molecular-weight-heparin, newer oral anticoagulants) 3) extended therapy that continues beyond 3 months with no scheduled end date
What is the goal of extended therapy?to prevent development of new episodes of venous thromboembolism (VTE)
The choice of length of therapy depends on many factor, list three?1) type of VTE (including location of DVT) 2) presence or absence of provoking factor 3) patient characteristics
In patients with an unprovoked DVT of the leg (isolated, distal or proximal), anticoagulation is recommended for at least ___ months?3
After 3 months of anticoagulation,w hat should be done for the patient?patient should be evaluated to determine their individual bleeding risk
*** In patients with low to moderate bleeding risk, what is recommended in way of anticoagulation?extended lifelong anticoagulation therapy
*** What reevaluation of bleeding risk and risk-benefit ratio is necessary, how often?annually
*** If the patient has a high bleeding risk, what is the recomemendation?3 months of anticoagulation
Do the above recommendations apply to RECURRENT unprovoked DVTs adn PE?yes
What type of anticoagulation for unprovoked DVTs is recommended, why?long-term; because of the high risk of RECURRENT VTEs
STudies have shown the risk of VTE recurrence to be ___% at 1 year and ___% at 5 years for those with unprovoked events?10; 30
PROVOKED VTE due to major or minor transient risk factors (surgery, trauma, medications) have a ______(lower vs. higher) rate of recurrence?lower
When determining individual bleeding risk on anticoagulation, list the risk factors to be considered?1) age > 65 years old 2) hx of prior GI bleed 3) prior bleed on Warfarin 4) renal impairment 5) hepatic impairment 6) concurrent antiplatelet therapy 7) frequent falls 8) thrombocytopenia 9) active cancer
In patients who are low to moderate bleeding risk, do the benefits of anticoaulation generally outweigh the risk?yes
Patient's values and preferences should also be discussed when deciding whether to indefinitely treat with anticoagulation. This includes what factors? 1) cost of medication 2) burdens associated with treatment 3) ongoing need for monitoring 4) follow-up
*** SUMMARY = In patients with an unprovoked DVT of the lower extremity (isolated, distal or proximal), anticoagulation is recommended for at least ___ ______?3 months
*** SUMMARY = Individuals with unprovoked DVT and low to moderate bleeding risk benefit from what duration anticoagulation?extended lifelong