5. Venous Thromboembolism

Question 1

Name the three corners of Virchow’s Triad

Answer 1

Stasis of blood

Hypercoagulation state

Trauma/Endothelial injury

Question 2

DVT/PE risk factors

Answer 2

MALIGNANCY

Hereditary = FACTOR V LEIDEN

Prior thromboembolism, recent surgery, trauma, immobilization, phospholipid antibodies (autoimmune), pregnancy, oral contraceptives, myeloproliferative disorders

Question 3

DVT symptoms

Answer 3

SWELLING

Pain/tenderness

Localized warmth

Redness

Question 4

DVT diagnostics

Answer 4

D-DIMER blood test
Sensitive but not specific
Clot breakdown of any kind increases d-dimer in blood

Negative d-dimer can effectively rule out DVT

VENOUS ULTRASOUND = test of choice
Better for proximal than distal clots

Venography = GOLD STANDARD
But rarely done in real life

Question 5

DVT treatment

Answer 5

Proximal DVT:
Anticoagulant
If AC CI, then IVC filter placed

Distal DVT:
If large clot, or lots of swelling, treat as above
If not that concerning, follow up in two weeks

Question 6

Pulmonary embolism symptoms

Answer 6

MOST COMMON = DYSPNEA

Pleuristic chest pain

Hemoptysis

Question 7

Pulmonary embolism diagnostics

Answer 7

CT PULMONARY ANGIOGRAM = test of choice

Ventilation-perfusion (V-Q) lung scanning

Question 8

Pulmonary embolism treatment

Answer 8

Thrombolytic therapy = tx of choice if life threatening

Supplemental O2

Surgical or catheter embolectomy if t-PA is CI