Deep Venous Thrombosis (DVT) Flashcards
Define DVT
Thrombus developing in the venous circulation
Risk factors for DVT
Immobility
Recent surgery
Long haul travel
Pregnancy
Hormone therapy with oestrogen (combined oral
contraceptive pill and hormone replacement therapy)
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia
Give examples of thrombophilias which may predispose patients to DVT
Antiphospholipid syndrome
Factor V Leiden
Antithrombin deficiency
Protein C or S deficiency
Hyperhomocysteinaemia
Prothombin gene variant
Activated protein C resistance
Antiphospholipid syndrome
Recurrent miscarriages
Blood test for antiphospholipid antibodies
DVT presentation
Almost always unilateral
Calf or leg swelling
Dilated superficial veins
Tenderness to the calf (particularly over the site of the deep veins)
Oedema
Colour changes to the leg
Diagnosis of DVT
D-dimer is sensitive but not specific
Doppler USS
Initial management in DVT
Anticoagulation with treatment dose apixaban or rivaroxaban
Catheter-directed thrombolysis in patients with symptomatic iliofemoral DVT and symptoms lasting >14 days
Long-term management of DVT
DOAC, warfarin or LMWH
First line anticoagulant in antiphospholipid syndrome
Warfarin
First line anticoagulant in pregnancy
LMWH
For how long is anticoagulation provided in DVT?
3 months if there is a reversible cause (then review)
Beyond 3 months if cause is unclear, there is recurrent VTE, or there is an irreversible underlying cause such as thrombophilia (often 6 months in practice)
3-6 months in active cancer (then review)
Investigating unprovoked DVT
Screen patients for: Antiphospholipid syndrome (check antiphospholipid antibodies)
Hereditary thrombophilias (only if they have a first-degree relative also affected by a DVT or PE)
