(!) Deep vein thrombosis

Question 1

Define DVT

Answer 1

Clotting in the veins of leg, abdominal, pelvis
can result in impaired flow which causes swelling and pain of the leg
can cause PE

Question 2

Aetiology and risk factors of DVT

Answer 2

Aetiology-Virchows triad-
Flow disturbance (laying still-no muscle pump of blood), clotting disorders (Oestrogen pill, etc), Endothelial disruption (smoking, etc)

associated with:
recent immobilisation (hospitalisation, surgery, long flights, trauma)
Malignancies
medical illnesses with inflammation
oral contraceptive pill
Age
Pregnancy
past DVT

Question 3

Epdiemology of DVT

Answer 3

Common 1:1000

20-50% of surgery patients

Question 4

Symptoms and signs of DVT

Answer 4

Symptoms-often goes missed
painful swollen legs/calf
can have fever

Signs-calf warmth, tenderness, swelling, fever, erythema, pitting oedema

Question 5

Tests for DVT

Answer 5

D-Dimer- sensitive for thrombosis, but not specific for DVT (low D dimer and low Wells score-can exclude)
Ultrasound-best diagnostic test
Thrombophilic test-give a clue

Question 6

Management for DVT

Answer 6

Prevent-stop the pill pre operation, mobilise early
LMWH and compression stockings for all
can use DOACS

Treatment-LMWH immediately (dependent on weight and time) or DOAC (Xa inhibit)
IF LVMH-Warfarin with LVMH
Stop heparin at INR 2-3, treat for 3 months post op (6 if can’t find a cause)

Exercise
Stockings

Question 7

Complications of DVT and its management

Answer 7

DVT-
High risk and chance-can become PE-type 2 respiratory failure and cardiac arrest

Management-
Large bleed during initial treatment-DOAC can help reduce that -also consider reversing agents

Heparin thrombocytopena

Question 8

Prognosis for DVT

Answer 8

With anticoagulant, chances of VTE are 0.4 (but if happens, 12% mortality)

extend and time to treat of initial clot is big factor
and co-morbities

once had one-risk of having more