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WorksheetsCancer-Associated VTE
Total questions: 23
Worksheet time: 15mins
The hemostatic system is responsible for
Protecting the integrity of vascular system
Works alongside bodily mechanisms involved in repair and inflammation
Dormant until activated by an offending agent such as an injury, drug, or cance
Ultimate response is the production of a platelet plug, a fibrin-based clot, deposition of white blood cells at the location of injury
Activating the inflammation and repair processes
What is a major focus point in fibrin production?
Coagulation Cascade
Fibrin
Factor X
Factor XI
How do tumor cells (solid and hematological) activate coagulation
Through tissue factor expression
Through Factor X expression
Through production of anti-coagulant activites
Through the release of proinflammatory and proangiogenic cytokines including
Prothrombin, Fibrinogen and Thrombin are all primary objects of what process when treating VTE
Plaque formation
RAAS
Coagulation Cascade
Thrombolytic Rupture
Tumor cells activate coagulatuin via
Indirect interaction with vasculature
Vessel wall damage
Vessel stasis
Platelets
True/False: Patients with active cancer are at a greter risk for VTE
True
False
Cancer treatment medications that are associated with VTE and therefore often require prophylaxis include
Aromatase inhibitors
Antimetabolites
Selective Estrogen Receptor Modulators
Immunomodulators
Risk factors that specifically affect cancer patients include
Remissive Cancer
Advanced stage cancer
Bulky lymphadenopathy with extrinsic vascular compression
Older Age
Cancer types at higher risk include
Brain
Pancreas
Stomach
Metastatic
Skin
Would the following patient be counted as a high-rick outpatient on chemotherapy? Mr Lane, 65, bladder cancer, prechemo WBCs 400,000/mcL, Hgb 12 g/dL
Yes
No
Treatmetn related risk factors for VTE include
Minor Surgery
IV Catheter
Hormone replacement therapy
Proteasome inhibitors
Immunomodulatory imide drugs plus high-dose dexamethasone
What is the typical duration of treatment for cancer related VTE?
3 weeks
3 months
6 weeks
6 months
A VTE prevention/treatment regimine can be based on what factors?
Cost
Bleeding Risk
Reverse anticoagulation ability
Kidney/Liver Function
Bleeding risk
When patients begin VTE treatment/prevention what are baseline labs that should be performed?
CBC
LFTs
aPTT/PT/INR
FBG
When monitoring cancer patients who are recieving VTE prophylaxis they should be monitored every 2-3 days for the first ___ days, then every ___ weeks or as clinically indicated
7, 2
10, 4
14, 3
14, 2
When is VTE prophylaxis indicated in inpatient cancer treatment patients?
Rarely
Mostly
Only if a surgery is performed
Only if a patient is hospitalized with a high risk cancer
Prophylactic VTE options for inpatient populations includes all of the following except
Unfractionated heparin (UFH)
Low molecular weight heparin (LMWH)
Warfarin
Fondaparinux (Arixtra®):
What are some of the patient characteristics the Khorana Predictive Model for Chemotherapy-Associated VTE uses to calcualte risk for VTE?
Site of primary cancer
BMI
Prechemo leukocyte count
ASCVD
Pemchemo platelet count
Cancer treatment patients with an intermediate ot high risk for VTE (Khorana score > or = 2) should have what type of therapy considered?
No routine VTE prophylaxis
Oral anticoagulants
UFH
Arixtra
Contraindications to Prophylactic Anticoagulation include
Thrombocytopenia
Platelets <30,000-50,000/mcL
Abnormal aPTT, PTT
Acute DVT
Contraindications to Mechanical Prophylaxis include
Acute DVT
Skin ulcerations or wounds
Thrombocytopenia
Large hematoma
What is the preferred VTE prevention medication in patients with a gastric ulceration
DOACs
UFH
LMWH
Warfarin
Seelct the appropriate warfarin dosing for VTE prophylactic treatment in cancer pateints.
10 mg PO BID for 7 days followed by 5 mg PO BID
1 mg/kg SC every 12 hours or 1.5 mg/kg QD
5 mg QD adjusted to INR of 2-3 (2.5 mg initial dose if liver disease)
SC 250 units/kg BID
