6: DVT and pulmonary embolism Flashcards
DVT and PE are collectively known as ___ ___ disease.
venous thromboembolic
In DVT, thrombi form in venous __ pockets.
valve
What is a DVT?
Formation of a thrombus within the lumen of the vessels which make up the deep venous system
Where are distal DVTs found?
In the calves (anywhere below the popliteal vein)
Where are proximal DVTs found?
At or above the popliteal vein
Venous thromboembolic diseases like DV and PE are strongly associated with ___.
cancer
The biggest risk factor for thromboembolic disease is __ __.
major surgery
Which genetic condition increases your thrombophilia?
Factor V Leiden
Thromboembolic disease can be divided into those which are ___ and un___.
provoked , unprovoked
If you have had a thrombus, you (are / aren’t) likely to have another one.
are
Which GI condition increases the likelihood of developing DVT/PE?
Crohn’s disease
What is the clinical presentation of PE?
Breathlessness
Pleuritic chest pain
Haemoptysis
Collapse
What is the clinical presentation of DVT?
Red, hot, swollen calf/calves
What is post thrombotic syndrome?
A pain/dysfunction syndrome affecting mainly the legs
Why do people get post thrombotic syndrome after DVT treatment?
Valve has been removed - pressure in deep venous system increases and damages further valves
What is the clinical presentation of post thrombotic syndrome?
Pain
Oedema
Hyperpigmentation
Eczema
Varicose veins
Ulcers
What is a chronic complication of PE?
Chronic thromboembolic pulmonary hypertension
What is a consequence of chronic thromboembolic pulmonary hypertension (CTEPH)?
Right heart failure
What is the initial presentation of CTEPH, a complication of PE?
Progressive breathlessness, hypoxaemia and death
What can be used instead of massive tests to estimate someone’s probability of DVT?
Pre-test probability scores
What test is used to exclude DVT?
D-dimers (good rule out test, rubbish rule in test)
High = no DVT
Low = maybe DVT
What investigation involves compressing veins to rule out DVT?
Ultrasound
If pressure upstream is high (due to blockage) then vein won’t compress very well
D-dimers are produced upon breakdown of __.
This gives an indication of the extent of ___.
fibrin
fibrinolysis (clot breakdown)
look over d-dimers again
Which two scores can be used to estimate the likelihood of PE?
Wells score
Geneva score
What is the gold standard investigation for diagnosing PE?
CT pulmonary angiogram
In PE, chest x-rays are usually ___.
What may you see on a chest x-ray indicating PE?
normal
Wedge-shaped infarctions
Which type of scan may you want to do to check for PE in a pregnant woman, where you want to limit radiation dosage to her and the foetus?
V/Q scan (usually perfusion only)
Which pharmacological interventions are used to treat DVT & PE?
ANTICOAGULATION (WARFARIN / RIVAROXABAN)
THROMBOLYSIS
ANALGESIA
Name two mechanical interventions which can be used to treat DVT & PE.
Compression stockings
IVC filters
Does an IVC filter block out all clots?
No
Which conditions would DVT/PE patients be screened for?
Cancer (only if red flag symptoms are met e.g blood in stool, unexplained weight loss)
Thrombophilia
look at nice guidelines for dvt/pe treatment
What is an advantage of warfarin over new drugs (e.g rivaroxiban)?
Warfarin anticoagulation can be reversed with Vitamin K
What is an advantage of new anticoagulant drugs e.g rivaroxiban?
Act predictably
Large therapeutic windows
Few interactions
What is a disadvantage of new anticoagulant drugs (e.g rivaroxiban)?
Irreversible (i.e no antidote if you overdo it) but not much of a problem
What are the two main NOACs used in DVT/PE?
Apixaban
Rivaroxaban
(Also dabigatran and edoxaban but these are rarely used.)
What do rivaroxaban and apixaban inhibit?
Factor Xa
(forms thrombin from prothrombin)
Rivaroxaban is (safer / more dangerous) than warfarin.
safer
In treatment of DVT/PE, the risk of ___ has to be balanced with the risk of death by ___.
haemorrhage
the embolic disease itself
In people with cancer-associated clotting, __ is the first line treatment.
fragmin
phlegmasia
