Blood diseases

Question 1

Features of DVT Wells criteria

Answer 1

• Unilateral calf swelling >3cm, whole leg swelling
• Previous DVT/PE
• Pitting oedema
• Active malignancy
• Paralysis/ paresis/ leg in cast
• Surgery within 12 weeks using GA/ RA / Bed-ridden 3 days
• Tenderness along deep system

Question 2

Wells score ______ indicates that DVT is likely

Answer 2

2+

Question 3

Wells score showing that DVT is unlikely, what is the next management?

Answer 3

D-dimer test for exclusion

Question 4

Features of PE Wells criteria

Answer 4

3 points

• Previous DVT/PE
• PE diagnosis is lkely

1. 5
   - HR >100
   - Immobolisation > 3 days/ surgery in 4 weeks

1 point

• Haemoptysis
• Malignancy treatment within 6 months

Question 5

First line management of suspected PE in pregnant/ post-partum women in GP

Answer 5

Referral for in-hospital assessment and management

- 6-weeks post-partum

Question 6

In Wells score that are likely _______ is done within ______

Answer 6

Proximal leg scan within 4 hours.

Question 7

If proximal leg scan cannot be carried out within 4 hours for suspected DVT, what is the alternative?

Answer 7

• D-dimer
• Interim anticoagulation
• Proximal leg scan within 24 hours

Question 8

Management of DVT unlikely in Wells score

Answer 8

D-dimer within 4 hours

Interim anticoagulant if not within 4 hours

Question 9

Management of negative D-dimer for DVT

Answer 9

Stop interim anticoagulation

Explain diagnosis

Question 10

What medications are used as interim anticoagulants for DVT

Answer 10

1st line= Xa DOAC

• Apixaban
• Rivaroxaban

2nd line

• LMWH 5 days, then dabigatran/edoxaban
• LMWH + warfarin

Question 11

Follow up for confirmed DVT

Answer 11

Maintenance therapy with oral anticoagulant
- At least 3 months

Monitoring

• Warfarin- INR 2-3
• None for DOAC

Investigate if DVT was unprovoked (cancer, thromophilia)