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R9 > Chapter 145 - Acute DVT introduction > Flashcards

Chapter 145 - Acute DVT introduction Flashcards

1
Q

DVT Epidemiology

A

Men > woman Higher in Hispanic, asian/pacific islanders

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2
Q

In hospital patients with highest risk of DVT

A

1) acute spinal cord injury 2) trauma 3) neurosurgery 4) ICU patients 5) major orthopedic 6) ward patients

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3
Q

Risk factors of DVT

A

1) hospitalization 2) surgery 3) trauma 4) cancer 5) chemotherapy 6) varicose veins at young < 60 age 7) congestive heart failure 8) age

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4
Q

Caprini score for DVT risk

A

FIGURE 145.1

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5
Q

Incidence of DVT from age 30 to age 80

A

increase 30 fold

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6
Q

Other risks that increase with age and therefore predispose DVT

A

1) acquired prothrombotic state (higher thrombin) 2) increased stasis in venous valve pockets 3) anatomical changes in soleal veins 4) increase biological markers

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7
Q

Typical clinical scenario in children who acquire VTE

A

1) scoliosis with halo-femoral traction immobolization 3.7% 2) ICU admission 4% 3) spinal cord injury 10%

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8
Q

Immobilization risk for DVT time line

A

Increases at 3 days very high risk after 2 weeks

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9
Q

Risk factors for getting DVT in travels

A

1) no compression stocking 10% risk 2) > 5000 km (150x risk) 3) previous VTE (OR 63.3) 4) trauma (13.6) 5) varicose veins (10) 6) obesity (9.6) 7) immobility during flight (9.3) 8) cardiac disease (8.9)

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10
Q

DVT presented that were recurrences (%)

A

23-26%

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11
Q

Risk of recurrent DVT with heterozygous factor V Leiden

A

40% at 8 years 2.4x higher than normal

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12
Q

Percentage of recurrent DVT due to hyperhomocysteinemia

A

17%

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13
Q

Percentage of first time VTE associated with malignancy

A

20% 4x higher risk than those without cancer

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14
Q

Cancer types associated with highest VTE risk

A

1) pancreas ++ 2) kidney 3) ovary 4) lung 5) stomach

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15
Q

Mechanisms in which cancer may increase VTE

A

1) mass effect venous compression 2) thrombocytosis 3) immobility 4) indwelling central lines 5) chemotherapy 6) radiation therapy 7) Tumor increase TF expression –> activate FX and XI –> thrombin 8) cancer procoagulant –> activate FX 9) platelet adhesion to tumor cells via glycoprotein Ib and IIb/IIIa

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16
Q

Difference between TF and CP in activating factor X

A

TF requires FVII CP activates X without FVII

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17
Q

How does IL-1 and TNF alpha cause VTE

A

1) downregulate thrombomodulin (thrombin receptor) on endothelial surface –> decrease thrombin-thrombomodulin complex –> decrease protein C activation 2) stimulate PAI-1 production –> inhibit fibrinolysis

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18
Q

Most common abnormalities in coagulation parameter in cancer

A

1) elevated fibrinogen 2) thrombocytosis 3) elevated coagulation factor 4) elevated fibrin degradation product 5) lower protein C and S

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19
Q

Coagulation peptide that reflect tumor activity

A

Fibrinopeptide A

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20
Q

Risk of DVT in treatment for non-Hodgkin’s lymphoma

A

6%

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21
Q

Risk fo DVT in treatment for breast cancer

A

17.5%

22
Q

Chemotherapy mechanism in causing DVT

A

1) direct endothelial toxicity 2) hypercoagulable state 3) reduced fibrinolytic activity 4) tumor cell lysis 5) central venous catheters

23
Q

Marker for increased risk in cancer patients for DVT

A

soluble P-selectin

24
Q

Strongest predictor from the VA study on post-surgery DVT

A

1) MI 2) blood transfusion > 4 units 3) UTI

25
Q

Risk of VTE in pregnancy

A

6-10x 1.3-7% during 6.1-23% postpartum

26
Q

% of DVT in pregnancy in the left leg

A

97%

27
Q

Mechanism of increased DVT in pregnancy

A

1) compression 2) transient hypercoagulable state

28
Q

Hypercoagulable state in pregnancy

A

1) Increased fibrinogen, vWF, F2, 7, 8, 10 2) resistance to activated protein C 3) reduced protein S level

29
Q

Fibrinolytic system alternation in pregnancy

A

1) decreased tpa 2) increased PAI 1 and 2

30
Q

Percent of pregnancy-associated VTE that also have inherited thrombophilia

A

30-50%

31
Q

Risks associated with VTE in postpartum stage 6 weeks

A

1) maternal age 2) suppression of lactation 3) hypertension 4) assisted delivery

32
Q

Effects of estrogen in altering coagulation system

A

1) decrease PAI12 2)increase blood viscosity 3) increase fibrinogen 4) increase factor 7 and 10 5) increase platelet adhesion and aggregation 6) decrease antithrombin and protein S

33
Q

Factors that compound with oral contraceptives to increase DVT

A

1) surgery 2) Factor V Leiden 3) resistance to protein C 4) smoking

34
Q

Blood group associated with higher and lower risk of VTE

A

Type A higher Type O lower (less vWF)

35
Q

Ethnicity of DVT risk

A

1) highest in Europe 2) higher in central US

36
Q

Other non-coagulopathic diseases that increase DVT risk

A

1) UC 2) SLE 3) varicose veins

37
Q

First discovery that L > R for DVT risk

A

Virchow

38
Q

First cadaver study to show that right iliac artery can cause intimal hypertrophy of left iliac vein

A

May and Thurner

39
Q

Cockett syndrome

A

Cockett 1965 iliofemoral DVT secondary to compression of iliac vein surgical intervention can alleviate skin ulcers now called May Thurner syndrome

40
Q

May Thurner Syndrome key points

A

1) young to middle age 2) women 3) after multiple preg

41
Q

Anatomical rate of left iliac vein compression

A

22-32%

42
Q

Rate of left leg edema or DVT that also have iliac vein compression

A

37-61%

43
Q

Association between AAA and May Thurner

A

less chance because iliac artery more tortuous

44
Q

Popliteal vein entrapment key points

A

1) 10% with artery 2) 70% in females

45
Q

Obesity and DVT

A

1) not a risk factors for development of DVT 2) risk factor for recurrent DVT

46
Q

Rate of recanalization after acute DVT at 3 and 9 months via impedance plethysmography

A

67% in 3 months 92% in 9 months

47
Q

Rate of recanalization after acute DVT at 7 days and 90 days by duplex

A

44% at 7 days 100% at 90 days

48
Q

Generally within what time frame do most thrombus resolution after acute DVT occur

A

3 months

49
Q

DVT recurrence in 10 years

A

30%

50
Q

Risks for recurrent DVT

A

1) age 2) obesity 3) cancer 4) paresis

51
Q

Rate of PE in hospitalized patients autopsy and rate of PE-related mortality

A

26% found at autopsy 9% was cause of death

R9 (200 decks)

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