Deep vein thrombosis and pulmonary embolism

Question 1

List four Permanent Risk Factors for DVT

Answer 1

• Previous venous thromboembolism.
• Cancer (known or undiagnosed).
• Increasing age.
• Being overweight or obese.
• Male sex.
• Heart failure.
• Acquired or familial thrombophilia.
• Chronic low-grade injury to the vascular wall (for example vasculitis, hypoxia from venous stasis, or chemotherapy).

Question 2

List four temporary Risk Factors for DVT

Answer 2

• Immobility, significant trauma, or direct trauma to a vein.
• Hormone treatment (for example oestrogen-containing contraception or hormone replacement therapy).
• Pregnancy and the postpartum period.
• Dehydration

Question 3

List 4 risk factors used in the Well’s score

Answer 3

• active cancer (treatment ongoing, within 6 months or palliative)
• paralysis, paresis or recent plaster immobilisation of lower extremities
• recently bedridden for more than 3 days or major surgery within 12 weeks requiring general or regional anaesthesia
• localised tenderness along distribution go deep venous system
• entire leg swollen
• calf swelling 3cm larger than asymptomatic side
• pitting oedema confined to symptomatic leg
• collateral superficiale veins (non-varicose)

Question 4

Differential Diagnosis for unilateral swollen leg

Answer 4

Physical trauma:
•Calf muscle tear or strain.
•Haematoma (collection of blood) in the muscle.
•Sprain or rupture of the Achilles tendon.
•Fracture.

Cardiovascular disorders:
•Superficial thrombophlebitis.
•Post-thrombotic syndrome.
•Venous obstruction or insufficiency, or external compression of major veins (for example by a fetusduring pregnancy, or cancer).
•Arteriovenous fistula and congenital vascular abnormalities.
•Acute limb ischaemia.
•Vasculitis.
•Heart failure.

Other conditions including:
•Ruptured Baker's cyst.
•Cellulitis (commonly mistaken as DVT).
•Dependent (stasis) oedema.
•Lymphatic obstruction.
•Septic arthritis.
•Cirrhosis.
•Nephrotic syndrome.
•Compartment syndrome.

Question 5

NICE recommendations for VTE (DVT and PE) follow-up

Answer 5

Investigation for cancer
•NICE recommends that people diagnosed with unprovokedDVT who are not already known to have cancer should be offered the following investigations for cancer:
–A physical examination (guided by the person’s full history).
–A chest X-ray.
–Blood tests (full blood count, serum calcium, and liver function tests).
–Urinalysis.

Thrombophilia testing
•NICE recommends that if it is planned to stop anticoagulation treatment:
–Testing for antiphospholipid antibodies should be considered in people who have had unprovoked DVT.
–Testing for hereditary thrombophilia should be considered in people who have had unprovoked DVT and who have a first-degree relative who has had DVT.