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Q1: Virchow's triad (2 min)
"State Virchow's triad and how surgery causes VTE."
- Stasis (immobility, anaesthesia)
- Hypercoagulability (surgical stress, malignancy)
- Endothelial injury (surgical trauma)
Q2: Prophylaxis (3 min)
"What VTE prophylaxis do you use for a high-risk surgical patient?"
- ACCP high risk (Caprini 5 or more, about 6 percent baseline): LMWH or low-dose UFH plus elastic stockings or IPC
- Standard LMWH dose in the cited trials: enoxaparin 40 mg SC once daily
- Cancer abdominal/pelvic surgery: four weeks of LMWH (ENOXACAN II; ACCP Grade 1B)
- Hip or knee replacement: at least 10 to 14 days, extend up to 35 days; prefer LMWH; add IPCD in hospital
- Early mobilisation; no IVC filter for primary prevention
Q3: PE (2 min)
"A post-op patient collapses with dyspnoea and hypoxia. What do you do?"
- Treat as PE with hypotension until proven otherwise
- ABC: high-flow oxygen, IV access, call for help
- If stable enough: CTPA
- CHEST 2016: thrombolytic therapy for PE with hypotension, systemic over catheter-directed
- Do not quote an unsourced alteplase milligram recipe