Deep Vein Thrombosis

Question 1

Who do DVTs occur in. (2)

Answer 1

25-50% of surgical patients.

Many non-surgical patients as well.

Question 2

What is a features of below knee DVTs. (2)

Answer 2

65% are asymptomatic.

They rarely embolize to the lungs.

Question 3

What are the risk factors for developing a DVT. (10)

Answer 3

Increased age. 
Pregnancy. 
Synthetic oestrogen. 
Trauma. 
Surgery (especially pelvic/orthopaedic). 
Past DVT.
Cancer. 
Obesity. 
Immobility. 
Thrombophilia.

Question 4

What are the sings of a DVT on physical exam. (6)

Answer 4

Calf warmth/tenderness/swelling/erythema.
Mild fever.
Pitting oedema.

Question 5

What is the differential for a DV. (3)

Answer 5

Cellulitis.
Ruptured Baker’s cyst.
DVT.
Both of the above may coexist with a DVT.

Question 6

What tests should be done in a patient presenting with a DVT. *(4)

Answer 6

D dimer.
Ultrasound.
Thrombophilia testing before commencing anticoagulation therapy.
Investigate for underlying malignancy.

Question 7

How do you prevent DVTs. (5)

Answer 7

Stop the pill 4 weeks pre op. 
Mobilize early. 
LMWH. 
Graduated compression stockings. 
Fondaparinux (factor Xa inhibitor).

Question 8

How do you treat a DVT. (4)

Answer 8

LMWH or fondaparinux.
Cancer patients should receive LMWH for 6 months and then review. In others start warfarin with LMWH, stop heparin when INR 2-3.
Inferior vena caval filters may be used in active bleeding, or when anticoagulants fail to minimize risk of pulmonary embolus.
Graduated compression stockings help prevent long term complications of DVT.

Question 9

What are the long term complications of DVT. (3)

Answer 9

Pain.
Swelling.
Skin changes.