Cases- DVT/PE- Leah (?) Flashcards
What is Virchow’s Triad?
(cause of clotting)
- venous stasis
- endothelial injury
- procoagulant state
What is the “rule of 30s”? (3)
- 30% cases of DVT die in 30 days
- 30 % cases recur over a ten year period
- 30% pt’s develop post phlebetic syndrome; of which 10% get venous ulcers
3 populations with increased risk of DVT/ PE”
- older age
- males
- hospitalized
Which lower extremity thrombi are dangerous (anatomically)? List the 2 most likely to embolize to the lung:
- Those above the popliteal vein
- most dangerous are illiac and femoral; high risk for propogation to lung
How is risk of DVT assessed?
+1 for any of the following sx; -2 if another better diagnosis exists:
- casting
- cancer
- immobility/ hospitalziation/ paralysis
- tenderness
- swelling
- edema
- collateral vein formation
2 pts= moderate risk; 3 pts= high risk (53%)
An unprovoked DVT should raise a red flag that?
-cancer may be present
How is DVT evaluated? (First and second steps)
- Ddimer
- duplex US
D dimer first; unless high risk –> US first
Is D-dimer testing specific or sensitive?
- It is sensitive; negative test rules out DVT
- It is NOT specific; poor POSITIVE predictive value; cannot diagnose DVT based on D-dimers alone- must get duplex US
If ultrasound is negative in a high risk patient, how should you proceed?
-Get D-dimers;
if negative- no DVT is present
if positive- obtain serial duplex US
How is a DVT in the calf managed/ when are they treated? Are these high or low risk for propagation?
- low risk for propogation (15% in two weeks)
- use US to monitor for propogation over 2 week period
- treat only with evidence of propogatoon
*above popliteal vein= danger; below= usually ok
How is an upper extremity thrombus handeled?
- low risk
- can leave catheter in if it is the causative factor
How do you treat clots in cancer patients?
How often do they have recurrent clots?
always LMWH
rule of 30 still applies; 30% recur
Treatment for superficial clot?
Common superficial clot diagnosed?
- fondaparinux is preferred
- commonly seen in great saphenous vein
How are clots treated in pregnancy?
- LMWH preferred
- Remember that warfarin is NOT safe in pregnancy
When does HIT present?
5-12 days into treatment unless patient has received previous heparin treatment (can occur immediately in that case)
- look for 50% drop in platelet count
