Deep vein thrombosis

Question 1

What is haemostasis?

Answer 1

A sequence of physical and biochemical changes induced by tissue and blood vessel damage involving the formation and breaking down of blood clots

Question 2

What is venous thrombosis?

Answer 2

The abnormal activation of normal haemostatic processes resulting in clots in normal vessels or exaggerated clotting in response to minor injury

Question 3

What are the three factors that lead to venous thrombosis?

Answer 3

Venous stasis (Blood pooling as a result of reduced venous return)

Vessel endothelium damage

Hypercoagulability
(Greater risk of clot formation)

Question 4

What factors are important to venous return?

What are risk factors for reduced venous return/venous stasis?

Answer 4

Muscle action to pump veins and intact venous valve function are essential to successful venous return

Venous stasis risk factors:
- Obesity
- Pregnancy
- Heart failure
- Atrial fibrillation
- Inactivity

Question 5

What can cause endothelial damage?

Answer 5

Direct
- Surgery
- Trauma
- Burns
- Intravascular catheterisation

Indirect
- Chemotherapy
- Diabetes
- Sepsis

Question 6

What can cause hypercoagulability?

Answer 6

Certain medical states:
- Severe anaemia
- Certain cancers
- Increased red blood cells in the blood (Polycythaemia)
- Sepsis (Endotoxin release)

Medications (Particularly oestrogen based medications)

Smoking

Question 7

What are preventative measures for venous thrombosis?

Answer 7

Encourage mobilisation
Use thromb-embolus deterrent (TED) stockings to aid venous return
Management of diabetes
Safe chemotherapy administration
Smoking cessation
Prophylactic anticoagulant administration

Question 8

Where does superficial vein thrombosis (SVT) commonly occur?

What are the symptoms of SVT?

Answer 8

Commonly in lower limbs

Symptoms:
- Palpable, firm, cord-like veins
- May be itchy
- May be tender and/or warm to touch
- May be red
- Oedema may be present

Question 9

Where does deep vein thrombosis (DVT) commonly occur?

What are the symptoms of DVT?

Answer 9

Commonly in lower limbs

Symptoms:
- Unilateral oedema
- Tenderness on palpation
- Dilated superficial veins
- Warm to the touch & erythema
- May have paraesthesia

If in greater vessels, the symptoms could be bilateral and affect upper limbs too

Question 10

What is the main concerning complication of deep vein thrombosis (DVT)?

Answer 10

A pulmonary embolism, where a small part of the venous clot breaks off and travels to the lungs to form a pulmonary embolus

Question 11

What are the symptoms of pulmonary embolism?

Answer 11

Dyspnoea
Hypoxaemia

May be present
- Tachypnoea & Tachycardia
- Cough and/or wheezing
- Chest discomfort
- Coughing blood (Haemoptysis)