Deep Vein Thrombosis Flashcards

1
Q

Define deep vein thrombosis

A

Clot in the deep venous system of the lower limbs

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2
Q

What are the causes of DVT?

A
  • Active malignancy
  • Recent major surgery (esp. orthopaedic surgery)
  • Recent hospitalisation
  • Recent trauma
  • Increasing age
  • Pregnancy
  • Obesity
  • Thrombophilias e.g. factor V Leiden, protein C/S deficiency
  • Recent long haul flights
  • Oestrogen e.g. OCP, HRT
  • smoking
  • polycythaemia
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3
Q

What are the symptoms of DVT?

A
  • Calf swelling

* Calf pain

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4
Q

What are the signs of DVT?

A
  • Unilateral oedema

* Calf tenderness

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5
Q

What are the investigations fr DVT?

A

• Well’s score
- <2 = unlikely -> proceed to D-dimer
- >2 = likely -> proceed to venous duplex USS
• D-dimer (sensitive but non-specific)
- Normal – excludes DVT if Well’s score is also <2
- Elevated – proceed to venous duplex USS
• Venous duplex USS
• Venography is definitive but invasive
• Compression USS is preferred

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6
Q

What is the management for DVT?

A

Anticoagulation
• IV or SC unfractionated heparin
- Increased risk of bleeding (short half-life plus reversal with protamine sulphate and FFP)
- Renal/hepatic impairment
• IV or SC LMWH e.g. enoxaparin, tinzaparin
- Active cancer
- Pregnancy (SC)
• IV or SC fondaparinux
• IV or SC direct factor Xa inhibitors e.g. rivaroxaban
• Warfarin
- Co-administered with heparin/fondaparinux until INR is between 2 and 3
- Continue for at least 3 months

Monitoring
• INR
- Target range 2-3
- Monitor whilst co-administering warfarin
• APTT
- Monitor every 6h for first 24h
• Platelet count (HIT –see complications)

VTE prophylaxis
• Stockings
• Physical activity

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7
Q

What are the complications of DVT?

A
  • Pulmonary embolism
  • Bleeding
  • Post-phlebitic syndrome
  • Heparin-induced thrombocytopenia
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