Deep vein thrombosis -DVT Flashcards
what happen with untreated DVT?
1% died of PE
risk factors
-Recent major surgery <12 weeks
-Recent admission to hospital
-Current malignancy -ongoing Tx or <6 months or palliative
-Being bedbound >3 days
-Sepsis
-IV drug use (where the patient injects in the femoral vein).
-Pregnancy/pelvic masses
-Limb immobility such as recent fracture with crutches and plaster cast (POP)
-Previous DVT/PE.
-Thrombophilia or family history of PE/DVT
Clinical features
Non specific -not always present:
-leg pain with swelling
-warmth
-tenderness
dilated superficial veins in the affected leg
if suspecting DVT then look for what else?
S/S of PE:
-tachycardia
-hypoxia
-increase RR
-breathlessness
differential diagnosis
cellulitis
ruptured baker’s cyst
muscular tear
how to examine the affected leg?
Examine the affected leg for signs of plethora, deep vein tenderness,
swelling (measure both legs, 10cm distal to the tibial tuberosity),
oedema, and dilatation of the skin veins.
calf swelling >3 cm then the affected limb
how to calculate the clinical probability assessment score.
Well’s score
PERC score
if Well score is <2
D dimer
if Well score >2
doppler U/S of the affected limb
if D dimer is negative
DVT is less likely
further investigations
FBC
U&E
Glucose
CXR
ECG
observations -esp. HR, SO2, RR
D dimer if well’s score is <2
Well’s score
page # 123
normal thigh scan
femoral and popliteal vein
2 x normal scans 1 week apart
normal whole leg scan
femoral vein
popliteal vein
calf veins
only 1x normal scan needed
when to give therapeutic LMWH?
to all patients awaiting scan
Treatment of diagnosed DVT?
LMWH
rivaroxaban
apixaban (dose reduction in 7 days)
f/u
red flags
breathlessness
chest pain
Upper limb DVT can be seen in which conditions?
MCC: chemotherapy central or long line
clinical features of upper limb DVT
plethora and swelling of arms or face
diagnostic investigation of upper limb DVT
U/S of axillary, jugular and subclavian veins
CT scan of central vein
Tx of upper limb DVT
same as lower limb DVT
superficial thrombophlebitis
painful and tender area of skin
Diagnosis superficial thrombophlebitis
firm, tender superficial vein
overlying erythema
can superficial thrombophlebitis co exists with DVT?
yes
