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Preventative Measures in the ICU - Wolfgang Questions and answers
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Preventative Measures in the ICU -Wolfgang
What are the 3 components of Virchow's Triad that all ICU patients possess to
at least some extent
1) venous stasis - limited mobility in ICU plus being sick
2) Vascular injury - trauma, surgery, central lines
3) Hypercoagulable states
What does Virchow's triad indicate an increased risk of
DVT
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List the major risk factors for DVT
cancer;
previous DVT;
obesity;
trauma;
surgery
-other = immobility, age, central lines, acute illness, estrogens
Summarize the protocol for DVT prophylaxis established by the CHEST
guidelines
-without a contraindication, DVT prophylaxis should be started in all critical
care patients as early as possible
-Use drugs for prophylaxis when possible
-LMWH or LDUH suggested over no prophylaxis at all
-if bleeding risk, mechanical prophylaxis suggested over no prophylaxis at all,
but pharmacologic prophylaxis preferred
How does heparin (UFH/LDUH) work/what clotting factors does it inactivate?
, binds to antithrombin and catalyzes the inactivation of thrombin and factors
2a, 9a, 10a, 11a, and 12a
what monitoring is needed for heparin (UFH/LDUH) in DVT prophylaxis
heparin is not routinely monitored with labs when using prophylactic doses
What dose of heparin is recommended for DVT prophylaxis
5000 units SQ Q12H or Q8H
What is the renal function dose adjustment for heparin
no renal dose adjustment required; this is a benefit because kidney function
often fluctuates in these patients
List the names of the 2 LMWHs
Enoxaparin (Lovenox);
Dalteparin (Fragmin)
What is the major difference in terms of structure between LMWH and heparin
and what is LMWHs main effect?
The difference is the LMWH lacks a pentasaccharide that allows heparin to
bind to antithrombin
-LMWHs main effect is from Xa inhibition
What dose of enoxaparin is recommended for DVT prophylaxis
40 mg SQ Q24H
or
30 mg SQ Q12H
What is the renal function dose adjustment for enoxaparin
30 mg SQ Q24H for CrCl < 30
What dose of dalteparin is recommended for DVT prophylaxis
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