Deep vein thrombosis - (also covered in CVS) Flashcards
What did NICE update in 2020 regarding venous thromboembolism (VTE)?
NICE updated guidelines on the investigation and management of VTE, recommending direct oral anticoagulants (DOACs) as first-line treatment for most people with VTE.
What is the recommended treatment for patients with active cancer and VTE according to the 2020 guidelines?
DOACs are recommended for patients with active cancer, replacing the previous recommendation of low-molecular weight heparin (LMWH).
Is routine cancer screening recommended after a VTE diagnosis?
No, routine cancer screening is no longer recommended following a VTE diagnosis.
What should be performed if a DVT is suspected?
A two-level DVT Wells score should be performed.
What is the score for active cancer in the two-level DVT Wells score?
Active cancer (treatment ongoing, within 6 months, or palliative) scores 1 point.
What does a score of 2 points or more indicate in the DVT Wells score?
DVT is likely.
What should be done if DVT is likely?
A proximal leg vein ultrasound scan should be carried out within 4 hours.
What is the next step if the ultrasound scan for DVT is positive?
A diagnosis of DVT is made and anticoagulant treatment should start.
What should be done if the ultrasound scan is negative but the D-dimer is positive?
Stop interim therapeutic anticoagulation and offer a repeat proximal leg vein ultrasound scan 6 to 8 days later.
What should be done if DVT is unlikely (1 point or less)?
Perform a D-dimer test within 4 hours.
What type of D-dimer tests does NICE recommend?
NICE recommends either a point-of-care (finger prick) or laboratory-based test.
What is the cornerstone of VTE management?
The cornerstone of VTE management is anticoagulant therapy.
What anticoagulants are recommended as first-line treatment after a DVT diagnosis?
Apixaban or rivaroxaban (both DOACs) should be offered first-line.
What should be done if neither apixaban nor rivaroxaban are suitable?
Use LMWH followed by dabigatran or edoxaban, or LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin).
What is the recommended length of anticoagulation for all patients?
All patients should have anticoagulation for at least 3 months.
How is the continuation of anticoagulation determined?
It is determined by whether the VTE was provoked or unprovoked.
What is the typical treatment duration for a provoked VTE?
Typically stopped after the initial 3 months (3 to 6 months for people with active cancer).
What is the typical treatment duration for an unprovoked VTE?
Treatment is typically continued for up to 3 further months (i.e. 6 months in total).
What tool can be used to assess the risk of bleeding?
The ORBIT score can be used to help assess the risk of bleeding.
What does NICE state regarding continuing anticoagulation for patients with unprovoked DVT or PE?
Explain that the benefits of continuing anticoagulation treatment are likely to outweigh the risks.
What are the features of deep vein thrombosis?
Lower limb pain (often calf pain) and tenderness along the line of the deep veins.
This includes swelling, erythema, pitting oedema, and distension of superficial veins.
What type of pain is commonly associated with deep vein thrombosis?
Calf pain and tenderness along the line of the deep veins.
What are the signs of swelling in deep vein thrombosis?
Swelling, erythema, pitting oedema, and distension of superficial veins.
flow chart for investigating 2-level Wells test
2-level Wells test criteria and points
