Deep Vein Thrombosis + PTE: Presentation, Investigation and Therapy Flashcards
Thrombus
Clot arising in the wrong place
Thromboembolism
Movement of clot along a vessel
What are the 3 components of Virchow’s Triad?
- Stasis
- Hypercoagulability
- Vessel damage
What can causes stasis of blood?
- Bed rest
- Travel
What can cause hypercoagulability of blood?
- Pregnancy
- Trauma
What can cause vessel damage?
Athersclerosis
What is the prevalence of DVT?
1 in 1000
What is the prevalence of PE?
1 in 3000-5000
What is the case fatality rate?
1 to 5%
What percentage of autopsies are PEs found in?
20%
How is a venous thrombus described?
Red thrombus
What makes a venous thrombus red?
Fibrin and red cells
What does a venous thrombus result in?
Back pressure
What are venous thrombi principally due to?
Stasis and hypercoagulability
How is an arterial thrombus described?
White clot
What makes an arterial thrombus white?
Platelets and fibrin
What does an arterial thrombus result in?
Ischaemia and infarction
What are arterial thrombi principally due to?
Secondary to atherosclerosis
Give examples of venous thromboembolisms (4)
- Limb deep vein thrombosis
- Pulmonary embolism
- Visceral venous thrombosis
- Intracranial venous thrombosis
What are the signs and symptoms of DVT?
- Unilateral limb swelling
- Persisting discomfort
- Calf tenderness
- Warmth
- Erythema
- MAY BE CLINCIALLY SILENT
How is DVT diagnosed?
- Clinical assessment and pretest probability score (Wells score)
- Blood test: D-dimer if low pre-test probability score
- Imaging: compression ultrasound if positive D-dimer or high pre-test probability score
What is the potential long term consequence of DVT?
Post thrombotic syndrome
What is the incidence rate of post thrombotic syndrome?
20-60% within 2 years of DVT
How does post thrombotic syndrome present?
- Swelling
- Discomfort
- Pigmentation
- Ulceration in severe form
What are the signs and symptoms of PE?
- Pleuritic chest pain
- Dyspnoea
- Haemoptysis
- Tachycardia
- Pleural rub on auscultation
What are the signs and symptoms of a massive PE?
- Severe sudden onset dyspnoea
- Collapse
- Cyanosis
- Tachycardia
- Hypotensive
- Raise JVP
What can a massive PE result in?
Sudden death
How is PE diagnosed?
- Clinical assessment and pretest probability score (Wells score or Geneva score)
- Blood test: D-dimer if low pretest probability score
- Imaging: if D-dimer positive or high pretest probability score
What imaging would be carried out in the investigation of PE?
- Isotope ventilation/perfusion scan
- CT pulmonary angiogram
What are the potential long term consequences of PE?
- Most recover fully
- Pulmonary hypertension
What are the aims of treatment of VTE?
- Prevent clot extension
- Prevent clot embolization
- Prevent recurrent clot
What are the treatement options for VTE?
- Anticoagulation is the main treatment
- Thrombolysis reserved for massive PE
What parenteral options are there for anticoagulation?
- Unfractioned heparin
- Low molecular weight heparin
What are the enteral options for anticoagulation?
- Warfarin
- Direct Oral Anticoagulants
How can VTE be prevented in the hospital?
- Early mobilisation
- Anti-embolism stockings
- Other mechanical methods of thromboprophylaxis
- Pharmacological thromboprophylaxis
