Deep Vein Thrombosis Flashcards

1
Q

Define DVT?

A

Formation of a thrombus within the deep veins (most commonly in the calf or thigh)

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2
Q

What are the causes of DVT?

A

Deep veins in the legs are more prone to blood stasis, hence clots are more likely to form

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3
Q

What are the risk factors for DVT?

A
COCP (combined oral contraceptive pill)
Post-surgery
Prolonged immobility 
Obesity 
Pregnancy
Dehydration
Smoking 
Polycythaemia
Thrombophilia 
Malignancy
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4
Q

What is the epidemiology of DVT?

A

Very Common

Especially in hospitalised patients

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5
Q

What are the presenting symptoms of DVT?

A

Swollen limb

May be painless

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6
Q

What are the signs of DVT on physical examination?

A
Local Erythema, Warmth and swelling
Measure the leg circumference 
Varicosities (swollen/tortuous vessels)
Skin colour changes
Homan's sign
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7
Q

What is Homan’s sign?

A

Forced passive dorsiflexion of the ankle causes deep calf pain

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8
Q

How is risk stratified for DVT?

A

Using the Wells Criteria

If the score is 2 or more it is classifed as high risk

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9
Q

What would you do to examine for PE?

A

Check resp rate
Pulse oximetry
Pulse rate

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10
Q

What is the gold standard investigation for DVT?

A

Doppler Ultrasound

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11
Q

How does Impedance Plethysmography work for DVT?

A

Changes in blood volume results in changes of electrical resistance

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12
Q

What bloods would you do for a DVT?

A

D-Dimer which can be used as a negative predictor

Thombophilia screen if indicated

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13
Q

What investigations would you do if PE is suspected?

A

ECG
CXR
ABG

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14
Q

What is the management plan for DVT?

A

Anticoagulation
IVC Filter
Prevention

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15
Q

What do you do for anti-coagulation in DVT?

A

Heparin whilst waiting for warfarin to increase INR to the target range of 2-3
DVTs that don’t extend above the knee may be observed and anticoagulated for 3 months
DVTs that extend beyond the knee require anticoagulation for 6 months
Recurrent DVTs require long-term warfarin

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16
Q

When would you use an IVC filter?

A

If anticoagulation is contraindicated and there is a risk of embolism

17
Q

What would you do to prevent DVTs?

A

Graduated compression stockings
Mobilisation
Prophylactic heparin (if high risk e.g. hospitalised patients)

18
Q

What are the possible complications of DVT?

A

PE
Venous infarction (phlegmasia cerulea dolens)
Thrombophlebitis (results from recurrent DVT)
Chronic venous insufficiency

19
Q

What is the prognosis for patients with DVT?

A

Depends on extent of DVT
Below-knee DVTs have a good prognosis
Proximal DVTs have a greater risk of embolisation