1(E): DVT Flashcards
What is a DVT
Clot that forms in deep veins of the leg, thigh or pelvis
What outlines risk factors for DVT
Virchow’s triad
What is Virchow’s triad
- Hyper coagulability
- Stasis
- Endothelial Damage
What are hypercoagulable causes of DVT
- Factor V Leiden
- COCP
- Malignancy
- Pregnancy
What are endothelial damage RF for DVT
Smoking
What are ‘stasis’ risk factors for DVT
- Surgery
- Long-Haul Flights
- Varicose Veins
- Trauma
- Obesity
- Pregnancy
How does a DVT present clinically
- Unilateral calf swelling
- Heaviness = worse on walking, improved on rest
- Erythema, Warm
- Mild Fever
- Pitting oedema
How is calf swelling assessed
- Measure 10cm below tibial tuberosity and 10cm above upper edge of the patella. A difference of more than 3 increases risk of DVT
What is phlegmasia cerumen dolens
Formation massive DVT that occludes arterial and venous system
What part of veins do the majority of DVTs arise
Adjacent to the valves
What is the most common site of DVT formation and why
Soleal vein - as there are no functioning valves
What increases risk of illiac or pelvic DVT
Pregnancy or Surgery
What scoring system is used to assess risk of DVT
Two-levels wells score
What indicates a high-probability on two-level wells score
More than 2
What should be ordered if score >2 for suspected DVT
Proximal leg vein US
What is time-frame for proximal leg vein US
4 hours
If leg vein US cannot be done in 4h, what should be done
Give LMWH
If leg vein US is negative what is performed
D-Dimer
What score indicates low probability of DVT
Less than 2
What is performed if low probability of DVT
D-Dimer
If D-dimer test is positive what is performed
Proximal leg vein US
What should happen if suspect DVT in pregnant women and why
Send for urgent clinical assessment - as cannot calculate wells score and d-dimer will be falsely raised
What are all individuals with unprovoked DVT offered
- Physical Exam
- CXR
- FBC, Bone Profile, LFT, Urinalysis
What are all women over-40 with unprovoked DVT offered and why
CT CAP - to exclude ovarian malignancy
When is antiphospholipid tested for in DVT
Unprovoked DVT
When are hereditary thrombophillias tested for in DVT
Unprovoked DVT and first-degree relative with DVT or PE
How are DVTs prevented in hospital
- Early mobilisation
- LMWH (SC)
- Stop COCP
- Thromboembolic stockings
How long before surgery is COCP stopped
4-Weeks
What is first-line to managed DVT
LMWH
How long is LMWH/Fondaparinux continued for
5d or until INR is more than 2 - whichever is longer
What is now main treatment for DVT
Rivaroxaban
How long is Rivaroxaban continued for in DVT
3-months
When is Rivaroxaban continued for 6m
- High risk recurrence
- Unprovoked DVT
- Active cancer
AND, no increased risk of bleeding
What is main complication of DVT
PE
