Deep Vein Thrombosis + PE Flashcards
What causes a DVT to form? [1]
Stasis in the deep veins and/or hypercoagubility
What are the risk factors for DVT/VTE? [7]
- Aging
- Tissue Trauma
- Immobility, Obesity
- Smoking
- Pregnancy, Exogenous Oestrogen (e.g. the pill)
- Inherited Thrombophilia
- Some systemic diseases like cancer
What are the symptoms of a DVT? [4]
Persistent discomfort & calf tenderness
Warmth
Erythema (redness)
Unilateral Limb Swelling
How do we investigate a suspected DVT?
What does the score mean?
DVT likely: 2 points or more
DVT unlikely: 1 point or less
If a DVT is ‘likely’:
- USS within 4 hours, if the result is negative, a D-dimer test
- If USS not available within 4 hours a D-dimer test should be done within 24h, give LMWH while waiting
If a DVT is ‘unlikely’ (1 point or less)
1. perform a D-dimer test and if it is positive arrange:
USS within 4 hours
2. If USS not available within 4 hours, LMWH should be administered while waiting for the USS
How is a DVT treated? [3]
- Rivaroxaban (DOAC)
2. TED stockings
Where do VTEs most often lodge? [1]
In the pulmonary arteries making them Pulmonary Emboli
What are the symptoms of a normal PE? [5]
Pleuritic chest Pain Dyspnoea Haemoptysis Tachycardia And a pleural rub on auscultation
What other symptoms come with a massive PE? [6]
Collapse Cyanosis Sudden Death Low BP Raised JVP Altered heart sounds
What do Wells score mean for PE?
How do we investigate a suspected PE?
Name 3 additional tests that you would do as part of baseline investigations
What do Wells score mean for PE?
PE likely - more than 4 points
PE unlikely - 4 points or less
If a PE is ‘likely’
- arrange an immediate CTPA.
- If there is a delay in getting the CTPA then give DOAC while waiting
If a PE is ‘unlikely’
- arranged a D-dimer test
- If this is positive arrange an immediate CTPA.
- If there is a delay in getting the CTPA then give DOAC while waiting
If the patient has an allergy to contrast media or renal impairment a V/Q scan should be used instead of a CTPA.
- FBC and clotting status to rule out some important secondary causes for the VTE
- ECG
- Arterial Blood Gasses
How do we treat a PE? [4]
Rivaroxaban
Thrombolysis for a massive PE
Thrombectomy is possible but not used much these days
Vena Caval Filter - traps emboli before entering heart (recurrent PE)
When would we keep the LMWH and not use warfarin in a PE case? [2]
If the patient is pregnant
As Warfarin is teratogenic in the 1st trimester
How do we actively prevent VTEs in some hospital patients? [4]
Early mobilisation
Regular Movement
Anti-embolism compression stockings
Daily dalteparin injections
What makes up a Venous thrombus? [2]
Fibrin and RBCs. Hence its called a ‘red thrombus’
What makes up an arterial thrombus? [2]
Fibrin and platelets. Hence they’re called ‘white thrombi’
What typically causes venous thrombi? [2]
Hypercoagubility - Pregnancy or Trauma
And Stasis - Travel or bed-bound.
