Deep Vein Thrombosis

Question 1

What is it?

Answer 1

Blood clots that form in the deep veins of the legs

Question 2

Why does it happen?

Answer 2

It occurs in hypercoaguable states

Question 3

What does it cause?

Answer 3

Venous backlog in the leg and bits can break off and lodge in the lungs to form Pulmonary Emboli

Question 4

Is it common?

Answer 4

There are 1 in 1000 people per year, and occurs in 25-30% of surgical patients if VTE prophylaxis is not given

Question 5

Risk Factors (11)

Answer 5

Old age, pregnancy, synthetic oestrogen e.g COCP, trauma, surgery (especially orthopaedic and gynaecological), previous DVT, Cancer, obesity, immobility, thrombophilia, long haul flights

Question 6

Symptoms (6)

Answer 6

Unilateral symptoms, calf warmth, tenderness, swelling, redness, fever

Question 7

Signs (1)

Answer 7

Pitting oedema

Question 8

Differential

Answer 8

Cellulitis

Question 9

Investigations

Answer 9

D-Dimer, Ultrasound, Urinalysis, FBC, LFT, Ca, Chest Xray, CT of abdomen and Pelvis, Look for malignancy to explain the cause

Question 10

What score system is used?

Answer 10

WELLS score, points for individual symptoms and points for symptoms co-existing with chest symptoms

Question 11

First Line Treatment

Answer 11

LMWH of therapeutic dose (4500 units/Kg)

Question 12

Other treatment (3)

Answer 12

Graduated compression stockings, warfarin treatment, thrombolytic therapy to reduce damage to valves

Question 13

How can we prevent DVTs? (4)

Answer 13

Good hydration, stop COCP 4 weeks pre-op, Mobilise early, VTE prophylaxis