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STG 2017 > DEEP VEIN THROMBOSIS > Flashcards

DEEP VEIN THROMBOSIS Flashcards

1
Q

DVT is often symptomatic. T/F

A

True

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2
Q

DVT most commonly affects……

A

Deep veins of the lowewr limbs

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2
Q

Other sites affected by DVT

A

Upper limbs
Intracranial veins
Splanchnic veins

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3
Q

Complications of DVT

A

Pulmonary thromboembolism

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3
Q

Common risk factors for DVT

A

Obesity
Smoking
Prolonged immobility
Major surgery
Pregnancy and puerperium
Caesarian section
Malignancy
Inherited blood disorders
Oestrogen therapy
Medical conditions

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4
Q

Medical conditions that are associated with increasedrisk of DVT

A

Heart failure
SLE
Stroke
Nephrotic syndrome
Myocardial infarction

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5
Q

Contraindications to anticoagulants

A

Recent Intracerebral bleed
Severe liver disease
Active PUD
Bleeding disorders
Severe hypertension

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6
Q

Causes of DVT

A

Virchow’s triad
1. Blood stasis
2. Endothelial damage
3. Hypercoagulability

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7
Q

Symptoms of DVT

A

Swelling or firmness of affected limb (usually unilateral)
Pain in affected limb
Mild fever

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8
Q

Signs of DVT

A

Swelling of affected limb
Differential warmth
Tenderness
Redness
Pitting oedema
Prominent superficial veins

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9
Q

Well’s score for DVT probability

A
  1. Paralysis, paresis or recent orthopedic casting of lower extremity + 1
  2. Recently bedridden (>3 days) or major surgery within past 4 weeks + 1
  3. Localized tenderness in deep vein system+1
  4. Swelling of entire leg + 1
  5. Calf swelling 3 cm more than other leg (measured 10 cm below the tibial tuberosity) +1
  6. Pitting oedema greater in the symptomatic leg +1
  7. Collateral non varicose superficial veins +1
  8. Active cancer or cancer treated within 6 months + 1
  9. Alternative diagnosis more likely than DVT -2
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9
Q

Well’s score interpretation for DVT

A

3-8= High probability
1-2= Moderate probability
Less than 1=Low probability

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10
Q

Low pretest probability of DVT combined with a negative D-dimer test rules out DVT. T/F

A

True

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11
Q

What test is recommended when the Well’s score gives a low probability for DVT

A

D-dimer test

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12
Q

What test is recommended when the Well’s score gives a moderate to high for DVT

A

D-dimer test
Doppler/Compression ultrasound scan

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13
Q

Investigations necessary in DVT

A

D-dimer
Dople ultrasound
FBC
Thrombophilia screen

14
Q

When is a thrombophilia screen necessary in DVT

A

Patient’s with recurrent DVT

15
Q

Non-pharmacological interventions in DVT

A

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

16
Q

Treatment objectives in DVT

A

To prevent clot propagation and pulmonary embolism
To prevent recurrence

17
Q

Examples of regular exercise on long journey’s tp avoid DVT

A
  1. stopping on road journeys to take a walk
  2. moving about on a plane during long flights
  3. leg flexing exercises while seated
18
Q

First line for DVT prophylaxis

A

Heparin, SC,
Adults
5,000 units 8-12 hourly
Children
1 month-18 years; 250 units/kg 12 hourly

19
Q

Second line treatment for DVT

A

Enoxaparin or Dalteparin
and
Warfarin

20
Q

Second line for DVT prophylaxis

A

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

21
Q

First line for DVT treatment

A

Heparin and Warfarin

21
Q

Dalteparin dose for DVT treatment

A

Adults
200 mg/kg (max. of 18,000 units) daily
Children
12-18 years; 200 units/kg once daily (max 18,000 units
daily)
1 month-12 years; 100 units/kg 12 hourly
Neonates; 100 units/kg 12 hourly

22
Q

Dose for heparin in DVT treatment

A

Heparin, SC,
Children
1 month-18 years; 250 units /kg 12 hourly
Adults
250 units/kg stat, continue with 250 units /kg 12 hourly

OR

Heparin IV
Adults
80 units/kg stat. continue with 18 units/kg / hour
Children
1-18 years; 75 units/kg stat. continue with 20 units/kg/hour
1 month-1 year; 75 units/kg stat. continue with 25 units/kg/ hour
Neonates (term baby); 75 units/kg stat. continue with 25 units/kg/
hour
Neonates (< 35 weeks); 50 Units /kg stat. continue with 25 units/
kg/hour

22
Q

Enoxaparin dose in DVT treatment

A

Adults
1.5 mg/kg (150 units/kg) daily
Children
2 months-18 years; 1 mg/kg 12 hourly
1-2 months; 1.5 mg/kg 12 hourly
Neonates; 1.5-2 mg/kg 12 hourly

23
Q

Dose of warfarin for DVT treatment

A

Day 1 10mg
Day 2 10mg
Day 3 5mg- check INR
Continue 5mg until INR of 2 to 3 is achieved
Stop LMWH and continue with warfarin 2.5mg to 5mg or 7.5mg guided by a target INR of 2 to 3

24
Q

How long should patient be put on warfarin

A

3 to 6 months for temporary or unkown risk factor
Long-term anticoagulation for permanent risk factors such as thrombophilia

STG 2017 (88 decks)

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