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#passmed 2022 > DVT > Flashcards

DVT Flashcards

1
Q

What is a DVT? (2 things)

A
  1. Formation of thrombus (blood clot) in a deep vein
  2. Partially / completely blocks blood flow
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2
Q

What percentage of surgical patients do DVT occur in?

A

25-50%

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3
Q

Who should be assessed for DVT / PE risk and be offered prophylaxis if needed?

A

ALL HOSPITAL PATIENTS

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4
Q

What are the Risk Factors for DVT? (10 things)

A
  1. Age
  2. Pregnancy
  3. COCP / Hormone Therapy
  4. Obesity
  5. Immobility (Long flights / casts)
  6. Surgery (esp pelvic / orthopaedic)
  7. Trauma
  8. DVT Hx
  9. Cancer
  10. Thrombophilia

Make sure u ask ones in bold in OSCE

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5
Q

Why are Venous clots (DVT) easier to form than Arterial clots?

A

Arterial clots need damage to walls to form clots

Venous clots don’t

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6
Q

What is the Pathophysiology of a DVT? (3 things)

A

Virchow’s Triad

  1. Hypercoagulability: Increased Clotting Factor Synth + Increased Platelet adhesion –> Clot
  2. Endothelial Damage: inflamm / trauma –> Tissue factor exposure –> (Prothombin–>Thrombin) –> (Fibrinogen–>Fibrin) –> Clot
  3. Stasis: Immobilisation / Venous valve incompetence –> Blood stasis –> Clot
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7
Q

What are the factors that lead to the Hypercoagulability part of Virchow’s Triad? (7 things)

A

Hereditary causes:

  1. Antiphospholipid syndrome (causes recurrent miscarriages)
  2. Factor V Leiden
  3. Anti-thrombin 3 deficiency
  4. Protein C/S deficiency

Acquired causes:

  1. Cancer
  2. COCP / Hormone Replacement Therapy
  3. Pregnancy

A FAP COP

So if you see a patient w recurrent miscarriages, she probs has Antiphospholipid syndrome n is @ risk of DVT

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8
Q

What are the factors that lead to the Endothelial Damage part of Virchow’s Triad? (4 things)

A
  1. HTN
  2. Cigarette smoking
  3. Trauma
  4. Central Venous Access
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9
Q

What are the factors that lead to the Stasis part of Virchow’s Triad? (4 things)

A

Immobilisation (long flights / casts)

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10
Q

What are the CF of DVT? (7 things)

A
  1. 50% asymptomatic (bc venous collateral channels)
  2. Unilateral leg pain + swelling
  3. Calf warmth / tenderness / swelling (entire leg if extensive)
  4. Red
  5. Visible superficial veins (bc high venous pressure) (17%)
  6. Mild fever
  7. Pitting oedema
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11
Q

What investigations should you do for sus DVT? (3 things)

A
  1. Well’s Score
  2. D-DIMER
  3. Doppler US

In that order

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12
Q

What does the Well’s Score tell you in sus DVT?

A

The likeliness of a DVT

2+ score = DVT likely

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13
Q

What does the Well’s Score include? (4 things)

A
  1. Recent surgery
  2. Calf swelling over 3cm (compared to other leg)
  3. Cancer
  4. Pitting oedema

1 point each

Ders more but jus remember dese 4

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14
Q

What should you do if the Well’s Score is 2+, aka DVT = likely?

A

Do a D-DIMER

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15
Q

If your Well’s Score is 2+, but your D-DIMER is NIGGATIVE, what dis mean?

A

No DVT, go home nigga

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16
Q

If your Well’s Score is 2+, and your D-DIMER is POSITIVE, what dis mean?

A

Maybe a DVT –> Do a US to confirm

(only “maybe” bc other tings can raise D-DIMER too)

17
Q

What other tings can cause a raised D-DIMER? (5 things)

A
  1. Pneumonia
  2. Cancer
  3. HF
  4. Surgery
  5. Pregnancy
18
Q

If your Well’s Score is 2+, D-Dimer is positive, and US is NEGATIVE, what should you do?

A

Repeat US in 6-8 days

Bc ma mmkin Wells AND D-Dimer both positive n no DVT,wt u playing at

19
Q

What might you see in a US in DVT? (3 things)

A
  1. Increased / Decreased vein diameter*
  2. Absent colour flow (= completely blocked)
  3. Increased flow in surrounding superficial veins

*(Increased = Acute DVT / Decreased = Chronic DVT)

20
Q

What are the FIRST LINE management options for DVT?

A

DOACs (Apixaban / Rivaroxaban)

21
Q

What are the SECOND LINE management options for DVT? (2 things)

A

LMWH (Low Molecular Weight Heparin)

with

Dabigatran / Edoxaban (DOACs) OR Warfarin (Vit K antagonist)

22
Q

What is the FIRST LINE treatment for DVT but has severe Renal impairment / Antiphospholipid syndrome?

A

LMWH / Unfractionated Heparin

(DOACs not safe in Renal Impairment bc meant to be cleared by Kidney)

23
Q

What is the FIRST LINE treatment of DVT in Pregnancy / Breastfeeding?

A

LMWH

DOACs not safe in pregnancy / breastfeeding

24
Q

How long should DVT patients take their Anticoagulation meds for?

A

At least 3 months

25
Q

After 3 months of anticoagulation meds, what determines if a DVT pt should carry on / stops meds?

A

If DVT was provoked by an acc event (e.g immobilisation after surgery) (can stop)

or if they jus have acc risk factors (carry on taking for 3 more months)

26
Q

After 6 month course of anticoagulation meds (bc DVT was unprovoked), what should you do for a DVT pt who will now stop taking meds? (2 things)

A

Test them for:

  1. Antiphospholipid syndrome (check for antibodies)
  2. Hereditary thrombophilias (only if have 1st Degree FHx of DVT / PE)
27
Q

What are the complications of DVTs? (2 things)

A
  1. Pulmonary Embolism
  2. Post-thrombotic syndrome (50%)

#passmed 2022 (27 decks)

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