1(E): DVT Flashcards

1
Q

What is a DVT

A

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

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2
Q

What outlines risk factors for DVT

A

Virchow’s triad

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3
Q

What is Virchow’s triad

A
  1. Hyper coagulability
  2. Stasis
  3. Endothelial Damage
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4
Q

What are hypercoagulable causes of DVT

A
  • Factor V Leiden
  • COCP
  • Malignancy
  • Pregnancy
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5
Q

What are endothelial damage RF for DVT

A

Smoking

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6
Q

What are ‘stasis’ risk factors for DVT

A
  • Surgery
  • Long-Haul Flights
  • Varicose Veins
  • Trauma
  • Obesity
  • Pregnancy
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7
Q

How does a DVT present clinically

A
  • Unilateral calf swelling
  • Heaviness = worse on walking, improved on rest
  • Erythema, Warm
  • Mild Fever
  • Pitting oedema
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8
Q

How is calf swelling assessed

A
  • Measure 10cm below tibial tuberosity and 10cm above upper edge of the patella. A difference of more than 3 increases risk of DVT
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9
Q

What is phlegmasia cerumen dolens

A

Formation massive DVT that occludes arterial and venous system

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10
Q

What part of veins do the majority of DVTs arise

A

Adjacent to the valves

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11
Q

What is the most common site of DVT formation and why

A

Soleal vein - as there are no functioning valves

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12
Q

What increases risk of illiac or pelvic DVT

A

Pregnancy or Surgery

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13
Q

What scoring system is used to assess risk of DVT

A

Two-levels wells score

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14
Q

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

A

More than 2

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15
Q

What should be ordered if score >2 for suspected DVT

A

Proximal leg vein US

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16
Q

What is time-frame for proximal leg vein US

17
Q

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

18
Q

If leg vein US is negative what is performed

19
Q

What score indicates low probability of DVT

A

Less than 2

20
Q

What is performed if low probability of DVT

21
Q

If D-dimer test is positive what is performed

A

Proximal leg vein US

22
Q

What should happen if suspect DVT in pregnant women and why

A

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

23
Q

What are all individuals with unprovoked DVT offered

A
  • Physical Exam
  • CXR
  • FBC, Bone Profile, LFT, Urinalysis
24
Q

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

A

CT CAP - to exclude ovarian malignancy

25
When is antiphospholipid tested for in DVT
Unprovoked DVT
26
When are hereditary thrombophillias tested for in DVT
Unprovoked DVT and first-degree relative with DVT or PE
27
How are DVTs prevented in hospital
- Early mobilisation - LMWH (SC) - Stop COCP - Thromboembolic stockings
28
How long before surgery is COCP stopped
4-Weeks
29
What is first-line to managed DVT
LMWH
30
How long is LMWH/Fondaparinux continued for
5d or until INR is more than 2 - whichever is longer
31
What is now main treatment for DVT
Rivaroxaban
32
How long is Rivaroxaban continued for in DVT
3-months
33
When is Rivaroxaban continued for 6m
- High risk recurrence - Unprovoked DVT - Active cancer AND, no increased risk of bleeding
34
What is main complication of DVT
PE