Dr Jamal USMLE – DVT prophylaxis vs anticoagulation – cardiology lecture
This is one of the most highly questioned aspects while you’re rounding with your attending physicians on medicine cardiology or even surgeries and while my students are rotating i ask them those questions all the time and every single time they make a mistake and that’s why i’m doing this video basically students residents everyone has to differentiate between
Dvt prophylaxis and anticoagulation and basically dvt prophylaxis means that your blood is thin a little bit to prevent a deep vein thrombosis anticoagulation means that your blood is very very thin so let’s go through the agents that we use and in the hospital and see what are the doses and how can we use them now aspirin plavix and all other antiplatelet agents
Cannot be used for dvt prophylaxis or anticoagulation basically those are anti platelets they are not for prophylaxis and are not for all anticoagulation let’s go for the next agent which is warfarin we know that warfarin act as an antagonist for vitamin k and it’s variable how we use it between patients because patients react differently we don’t use it for dvt
Prophylaxis we use it for anticoagulation and things that you have to remember that it usually takes five days for it to work and you have to remember that it’s valuable patients act differently to the doses and you have to remember that if you really need the patient to be anticoagulated for the first five days you might need a the agent on top now what if someone
Develops a life-threatening bleeding what are you gonna do so ways to reverse it is vitamin k you can give them ffp but currently the answer if if this shows in in one of your questions it’s for bcc prothrombin complex concentrate now what about heparin can we use heparin for dvt prophylaxis yes and usually the dose is 5,000 units and we give them subcutaneously
Either be id or tid what about heparin for anticoagulation heparin for anticoagulation is only done through intravenous and we usually give a bolus followed by a trip means continuous and the reason why we do that is because heparin stays for a short time in the blood and you need it continuously in order to maintain anticoagulation again for heparin in order
To make sure that your blood is thin enough for the diagnosis that you need you have to keep on measuring the ptt and that will tell you if your blood is thin enough or not and the range for the ptt is different according to the diagnosis your anticoagulation for what about the low molecular weight heparin or what we call an oxy apparent or lovenox well for dvt
Prophylaxis that those is 40 milligrams sub-q once daily it’s very easy what about for anticoagulation does the anticoagulation does is weight based and it is 1 milligram per kilogram and you have to do that those twice a day so someone’s weight is 100 kilogram you give them 100 milligram sub-q 100 milligram sub-q in the morning and 100 milligram sub-q in the
Evening there’s another dose which is 1.5 milligram per kilogram and that’s just once daily sub-q you have to remember that lovenox with kidney dysfunction you might have to change the dose there is a way to see if the blood is thin enough which is factor 10 a si but it’s not used that much sometimes it might take two to three days for it to come back and some
Hospitals don’t even have that i say now what about the newer oral anticoagulants those are the ones that we see on tv apixaban debbie got ran rivaroxaban and then we have a doc seven their use is getting more frequent right now because they don’t need any frequent tests like the warfarin the warfarin patients have to go and get inr checked at the beginning you
Have to do it every two to three days and then weekly and then if the inr stabilizes you’ll do it every month and usually the normal eye on our is one but for anticoagulation you need that number to be above two if someone has a very high risk of from bojan a ct like someone who has a mechanical bout the doctors may actually recommend a higher cutoff like two and
A half to three and a half now the no works are really easy to easily used because they don’t need checking of any labs you just give the medication and their oral no injections no sub-q no iv and then they will work one thing that you have to remember is that every every one of those has a different dose and some of them have a certain dose for kidney dysfunction
And that makes it easier for us to use in patients who are old who are fragile the only downside of newer oral coagulant is that we don’t have reversal agents except for dobby kathrine where is there there is a reversal agent it’s very expensive and it’s directly against that we got ran now if you have a patient who is on a pick seban a toxin or a rock subban and
They come in with a significant bleeding in the head while you’re gonna do something you’re not gonna leave the patient alone in that case you will give them the for pcc which is the prothrombin complex concentrate the other question is can i use the know box for the dvt prophylaxis well i’m gonna tell you yes there are doses and usually orthopaedic service will
Use that but remember that those medications are really expensive so would you rather do this for dvt prophylaxis or would you do it with heparin or lovenox which is much cheaper and generative and those are the things that you have to consider whenever you give medications so to sum up make sure that you understand that dvt prophylaxis means that your blood is a
Little bit thin but not that thin anticoagulation means that your blood is really thin and we use it to medically treat mi pe dvt and those are your options recognize the difference between an oral iv and sub-q heparin can be given sub-q or ib an ox apparent can be given sub-q or iv but we usually use it in sub-q while no acts are given orally norwich’s and warfarin
Are the best treatment when you’re sending someone home and for a long term while heparin and an ox apparent are used in the hospital some patients who have cancer would require an ox apparent injections at home because it was shown that if someone has a dvt or pe and they have underlying malignancy and aqsa pattern is to go agent rather than warfarin and this is
A simple and a very summarised lecture about dvt prophylaxis and anticoagulation one thing i want you to remember aspirin and plavix will never be appropriate for dvt prophylaxis or anticoagulation
Transcribed from video
DVT prophylaxis vs anticoagulation – Dr Jamal USMLE – cardiology lecture By Dr Jamal’s USMLE Notes and Match Guide
