DEEP VEIN THROMBOSIS Flashcards
DVT is often symptomatic. T/F
True
DVT most commonly affects……
Deep veins of the lowewr limbs
Other sites affected by DVT
Upper limbs
Intracranial veins
Splanchnic veins
Complications of DVT
Pulmonary thromboembolism
Common risk factors for DVT
Obesity
Smoking
Prolonged immobility
Major surgery
Pregnancy and puerperium
Caesarian section
Malignancy
Inherited blood disorders
Oestrogen therapy
Medical conditions
Medical conditions that are associated with increasedrisk of DVT
Heart failure
SLE
Stroke
Nephrotic syndrome
Myocardial infarction
Contraindications to anticoagulants
Recent Intracerebral bleed
Severe liver disease
Active PUD
Bleeding disorders
Severe hypertension
Causes of DVT
Virchow’s triad
1. Blood stasis
2. Endothelial damage
3. Hypercoagulability
Symptoms of DVT
Swelling or firmness of affected limb (usually unilateral)
Pain in affected limb
Mild fever
Signs of DVT
Swelling of affected limb
Differential warmth
Tenderness
Redness
Pitting oedema
Prominent superficial veins
Well’s score for DVT probability
- Paralysis, paresis or recent orthopedic casting of lower extremity + 1
- Recently bedridden (>3 days) or major surgery within past 4 weeks + 1
- Localized tenderness in deep vein system+1
- Swelling of entire leg + 1
- Calf swelling 3 cm more than other leg (measured 10 cm below the tibial tuberosity) +1
- Pitting oedema greater in the symptomatic leg +1
- Collateral non varicose superficial veins +1
- Active cancer or cancer treated within 6 months + 1
- Alternative diagnosis more likely than DVT -2
Well’s score interpretation for DVT
3-8= High probability
1-2= Moderate probability
Less than 1=Low probability
Low pretest probability of DVT combined with a negative D-dimer test rules out DVT. T/F
True
What test is recommended when the Well’s score gives a low probability for DVT
D-dimer test
What test is recommended when the Well’s score gives a moderate to high for DVT
D-dimer test
Doppler/Compression ultrasound scan
Investigations necessary in DVT
D-dimer
Dople ultrasound
FBC
Thrombophilia screen
When is a thrombophilia screen necessary in DVT
Patient’s with recurrent DVT
Non-pharmacological interventions in DVT
Avoidance of prolonged recumbency and dehydration
Avoidance of excess amounts of coffee, tea and alcohol, especially on long journeys
Increase water intake during long journeys or periods of immobility
Regular exercise during long journeys
Avoid crossing legs for long periods on long journeys
Use of elastic compression stockings
Treatment objectives in DVT
To prevent clot propagation and pulmonary embolism
To prevent recurrence
Examples of regular exercise on long journey’s tp avoid DVT
- stopping on road journeys to take a walk
- moving about on a plane during long flights
- leg flexing exercises while seated
First line for DVT prophylaxis
Heparin, SC,
Adults
5,000 units 8-12 hourly
Children
1 month-18 years; 250 units/kg 12 hourly
Second line treatment for DVT
Enoxaparin or Dalteparin
and
Warfarin
Second line for DVT prophylaxis
Enoxaparin, SC,
Adults
40 mg daily
Children
2 months-18 years; 500 microgram/kg 12 hourly (max 40 mg)
1-2 months; 750 microgram /kg 12 hourly
First line for DVT treatment
Heparin and Warfarin
