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finals: medicine > Deep Vein Thrombus (DVT) > Flashcards

Deep Vein Thrombus (DVT) Flashcards

1
Q

DVT is caused by the partial or total occlusion of which vein(s)

A

The deep vein(s)

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2
Q

What deep veins are commonly occluded in DVT

A

Commonly affects the lower limbs but can affect any deep vein e.g. thigh, pelvis or abdomen

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3
Q

DVT is commonly seen alongside what other condition

A

Pulmonary embolism (PE)

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4
Q

DVT is rarely life threatening but it can when can it become life threatening

A

It can cause pulmonary embolism (PE)

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5
Q

Describe how the DVT can cause a PE

A

DVT occurs when a thrombus forms in the deep veins

an emboli from the thrombus of the deep veins can travel to the right side of the heart and into the lungs where it becomes lodged in the pulmonary arteries causing the PE

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6
Q

What causes Venous thromboembolism (VTE)

A

Occurs as a result of a clot (thrombi) developing in the circulation

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7
Q

Venous thromboembolism (VTE) encompasses two conditions.

Name the two conditions?

A

Pulmonary embolism (PE)

Deep vein thrombosis (DVT)

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8
Q

Name some of the risk factors for DVT

A

Active cancer

Trauma

Major surgery

Hospitalisation

Immobilisation

Pregnancy

Oral contraceptive use

NOTE: DVT can be unprovoked (idiopathic) and occur in the absence of any identifiable risk factors

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9
Q

What are some of the clinical features of DVT

A

Almost always unilateral

Asymmetrical leg swelling

Unilateral leg pain

Dilation or distension of superficial veins

Red or discoloured skin

Can also be asymptomatic

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10
Q

Define Thrombophilias

A

Refers to conditions that predispose patients to develop blood clots.

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11
Q

Give an example of a Thrombophilias

A

Antiphospholipid syndrome

Antithrombin deficiency

Protein C or S deficiency

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12
Q

What is the Probability Tool for PE/VTE

A

Wells Score

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13
Q

When is the Wells Score used

A

Used to predict the likelihood of a DVT/PE

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14
Q

When interpretating the Wells Score.

A score of what makes a DVT likely

A

Wells Score 2 or more

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15
Q

When interpretating the Wells Score.

A score of what makes a DVT unlikely

A

1 or less

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16
Q

Name some of the components of the Wells Score

A

Active cancer

Paralysis, paresis or recent plaster immobilisation of the lower extremities

Recently bedridden for >3 days or major surgery within 12 weeks

Localised tenderness along the distribution of the deep venous system

Swelling of entire leg

Calf swelling (>3 cm larger than asymptomatic side)

Pitting oedema confined to the symptomatic leg

Prominent superficial veins (non-varicose)

Previously history of DVT or PE

An alternative diagnosis is at least as likely as DVT

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17
Q

What are the two key investigations for DVT

A

Doppler ultrasound

D-dimer (although not always needed)

18
Q

When is the doppler ultrasound used in investigating DVT

A

Wells score DVT likely = Doppler ultrasound done first without the need for a D-dimer first

Wells score DVT unlikely = require D-dimer first and only if that comes back positive should they undergo a doppler ultrasound

19
Q

If a doppler ultrasound is unable to complete within 4 hours of DVT suspicion. What should be given whilst they await the scan?

A

Interim anticoagulation

20
Q

Wells score likely

Initialy scan negative

d-dimer positive.

What is the next stage in investigating DVT?

A

Interim anticoagulation should be stopped and a repeat proximal leg vein ultrasound in 6-8 days

21
Q

Patient has a:

Wells score likely

Initialy scan negative

d-dimer positive

The next step is stopping interim anticoagulation and repeating proximal leg vein ultrasound when?

A

6-8 days

22
Q

For patients with a Well score likely.

What is the next step in investigating DVT

A

Ultrasound (if available within 4 hours)

If over 4 hours, give interim anticoagulation whilst they await investigations

23
Q

For patients with a Well score unlikely.

What is the next step in investigating DVT

A

D-dimer

24
Q

D-dimer is an important investigation for DVT.

At what stage is D-dimer used

A

Used when the Wells score DVT unlikely or if the initial ultrasound scan is negative

25
Q

How specific and sensitive is d-dimer in DVT

A

Highly sensitive but not specific i.e. can reliably exclude VTE but cannot confirm it

26
Q

Venous thromboembolism (VTE) is a cause of a raised d-dimer however it is not the only cause.

Name some other conditions that can cause a raised d-dimer

A

Pneumonia

Malignancy

Heart failure

Surgery

Pregnancy

27
Q

Wells score likely

Doppler Ultrasound negative

What is the next step in investigating DVT

A

Interim anticoagulation should be stopped and a repeat proximal leg vein ultrasound in 6-8 days

28
Q

Wells score unlikely

D-dimer negative

What is the next step in investigating DVT

A

Unlikely DVT

Think other diagnosis

29
Q

Wells score unlikely

D-dimer positive

What is the next step in investigating DVT

A

Doppler ultrasound

30
Q

What is the cornerstone treatment in the initial management of DVT

A

Anticoagulation

Should be started immediately in patients where:

  • DVT or PE is suspected
  • There is a delay in getting doppler ultrasound scan
31
Q

In most cases what is the anticoagulant of choice for the immediate management of DVT

A

Direct oral-acting anticoagulants (DOAC) e.g. apixaban or rivaroxaban

32
Q

After initial management, anticoagulant therapy is required to continue for a period of time to prevent future DVT/PE.

What are the anticoagulation options for these patients

A

DOAC

Low molecular weight heparin (LMWH)

Vitamin K antagonists i.e. warfarin

33
Q

After initial management, anticoagulant therapy is required to continue for a period of time to prevent future DVT/PE.

What is the anticoagulant used in the majority of cases

A

DOACs as it does not require monitoring

34
Q

What is the first-line anticoagulant in pregnancy [managing DVT]

A

Low molecular weight heparin (LMWH)

35
Q

What is the first-line anticoagulant in antiphospholipid syndrome [managing DVT]

A

Warfarin

36
Q

After initial management, anticoagulant therapy is required to continue for a period of time to prevent future DVT/PE.

What is the duration of this therapy?

A

3 months – for those with reversible cause

Beyond 3 months (typically 6 months) – if the cause is unclear, recurrent VTE, irreversible cause

3-6 months – active cancer

37
Q

After initial management, anticoagulant therapy is required to continue for a period of time to prevent future DVT/PE.

What is the duration of this therapy if there is a reversible cause of the DVT

A

3 months

38
Q

After initial management, anticoagulant therapy is required to continue for a period of time to prevent future DVT/PE.

What is the duration of this therapy if there is a cause is unclear, recurrent VTE, irreversible cause

A

Beyond 3 months (typically 6 months)

39
Q

After initial management, anticoagulant therapy is required to continue for a period of time to prevent future DVT/PE.

What is the duration of this therapy for those with active cancer

A

6 months

40
Q

What is a complication of DVT

A

Post-thrombotic syndrome

Presence of chronic swelling, pain and skin discoloration. In severe cases it can lead to ulcers and gangrene.

finals: medicine (91 decks)

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