Venous Thromboembolism (VTE) Fall 2012

Estrogen selective estrogen receptor modulators serms

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Estrogen Selective estrogen receptor modulators (SERMs) Tamoxifen, raloxifene Heparin-induced thrombocytopenia (HIT) Chemotherapy
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Risk Factors (Chest 2012) a. Local or distal metastases and/or in those with chemotherapy/radiation in last 6 months b. Anticipated bedrest for at least 3 days c. Defects: AT, Protein C or S, Factor V Leiden, APS, Prothrombin G20210A gene mutation High risk: > 4 Prevention of VTE In Nonsurgical Patients. Kahn SR, Lim W, Dunn AS, et al. CHEST. 2012;141(2_suppl):e195S- e226S. doi:10.1378/chest.11-2296.
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26-4
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Pathophysiology: Clotting Cascade (New)
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Pathophysiology: Clotting Cascade (Old) Initiation Amplification
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Propagation Pathophysiology: Clotting Cascade (Old)
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Clinical Presentation Jefferson Clinical Images The DVT forum. http://www.dvtforum.com/index.asp?action=start Accessed Nov. 5, 2012.
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Clinical Presentation Symptoms: Signs Silent Symptomatic: Limb swelling Limb pain Limb warmth Dilated/palpable cord Pain in back of knee Homans sign Elevated D-dimer Elevated ESR
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Diagnostic Testing Duplex ultrasound Venography http://www.ultrasoundpaedia.com/USP%20dvt%20winner.html Accessed Nov. 16, 2011.
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Consequences Pulmonary embolism Thrombophlebitis Post-thrombotic syndrome (chronic venous insufficiency)
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Pulmonary Embolism Obstruction of pulmonary blood flow Obstruction of pulmonary blood flow Bronchoconstriction
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