Cancer

Question 1

What is the management plan for DVT?

Answer 1

• Anti-coagulate - warfarin or NOAC
  
  • LMWH used for 48hrs whilst warfarin reaches INR target range
• Below knee DVT require 3 months of anti-coag + obs
• Above knee DVT require 6 months of anti-coag + obs
• IVC filter considered if Anti-coag is contraindicated or high risk of PE

Prevention - Graduated compression sockings

• Mobilisation
• Prophylactic heparin in high risk patients

Question 2

What is the management plan for Pulmonary Emboli?

Answer 2

• Primary Prevention - compression stockings, heparin prophylaxis for high risk, good mobilisation + hydration
• High/intermediate risk PE
  
  • If massive RESUS - ABCDE
  • 1st Line - IV fluids, vasoactive agents + LMWH + Warfarin
  • For massive PE > Thrombolysis with alteplase
• For Intermediate consider embolectomy or IVC filter (when recurrent or anti-coagulant is contraindicated)
• Low risk PE
  
  • 1st Line - Oxygen + Analgesia + LMWH/ NOAC
  • Consider IVC if recurrent or anti-coagulant is contraindicated
• Long-term Management
  
  • NOAC or warfarin for 6 months post event
  • If malignancy present use LMWH