1(E): DVT

Question 1

What is a DVT

Answer 1

Clot that forms in deep veins of the leg, thigh or pelvis

Question 2

What outlines risk factors for DVT

Answer 2

Virchow’s triad

Question 3

What is Virchow’s triad

Answer 3

1. Hyper coagulability
2. Stasis
3. Endothelial Damage

Question 4

What are hypercoagulable causes of DVT

Answer 4

• Factor V Leiden
• COCP
• Malignancy
• Pregnancy

Question 5

What are endothelial damage RF for DVT

Answer 5

Smoking

Question 6

What are ‘stasis’ risk factors for DVT

Answer 6

• Surgery
• Long-Haul Flights
• Varicose Veins
• Trauma
• Obesity
• Pregnancy

Question 7

How does a DVT present clinically

Answer 7

• Unilateral calf swelling
• Heaviness = worse on walking, improved on rest
• Erythema, Warm
• Mild Fever
• Pitting oedema

Question 8

How is calf swelling assessed

Answer 8

• Measure 10cm below tibial tuberosity and 10cm above upper edge of the patella. A difference of more than 3 increases risk of DVT

Question 9

What is phlegmasia cerumen dolens

Answer 9

Formation massive DVT that occludes arterial and venous system

Question 10

What part of veins do the majority of DVTs arise

Answer 10

Adjacent to the valves

Question 11

What is the most common site of DVT formation and why

Answer 11

Soleal vein - as there are no functioning valves

Question 12

What increases risk of illiac or pelvic DVT

Answer 12

Pregnancy or Surgery

Question 13

What scoring system is used to assess risk of DVT

Answer 13

Two-levels wells score

Question 14

What indicates a high-probability on two-level wells score

Answer 14

More than 2

Question 15

What should be ordered if score >2 for suspected DVT

Answer 15

Proximal leg vein US

Question 16

What is time-frame for proximal leg vein US

Answer 16

4 hours

Question 17

If leg vein US cannot be done in 4h, what should be done

Answer 17

Give LMWH

Question 18

If leg vein US is negative what is performed

Answer 18

D-Dimer

Question 19

What score indicates low probability of DVT

Answer 19

Less than 2

Question 20

What is performed if low probability of DVT

Answer 20

D-Dimer

Question 21

If D-dimer test is positive what is performed

Answer 21

Proximal leg vein US

Question 22

What should happen if suspect DVT in pregnant women and why

Answer 22

Send for urgent clinical assessment - as cannot calculate wells score and d-dimer will be falsely raised

Question 23

What are all individuals with unprovoked DVT offered

Answer 23

• Physical Exam
• CXR
• FBC, Bone Profile, LFT, Urinalysis

Question 24

What are all women over-40 with unprovoked DVT offered and why

Answer 24

CT CAP - to exclude ovarian malignancy

Question 25

When is antiphospholipid tested for in DVT

Answer 25

Unprovoked DVT

Question 26

When are hereditary thrombophillias tested for in DVT

Answer 26

Unprovoked DVT and first-degree relative with DVT or PE

Question 27

How are DVTs prevented in hospital

Answer 27

• Early mobilisation
• LMWH (SC)
• Stop COCP
• Thromboembolic stockings

Question 28

How long before surgery is COCP stopped

Answer 28

4-Weeks

Question 29

What is first-line to managed DVT

Answer 29

LMWH

Question 30

How long is LMWH/Fondaparinux continued for

Answer 30

5d or until INR is more than 2 - whichever is longer

Question 31

What is now main treatment for DVT

Answer 31

Rivaroxaban

Question 32

How long is Rivaroxaban continued for in DVT

Answer 32

3-months

Question 33

When is Rivaroxaban continued for 6m

Answer 33

• High risk recurrence
• Unprovoked DVT
• Active cancer

AND, no increased risk of bleeding

Question 34

What is main complication of DVT

Answer 34

PE