DVT

Question 1

What is virchows triad

Answer 1

Endothelial damage
Venous stasis
Hypercoagulablility

Question 2

List seven risk factors for DVT

Answer 2

Lower limb fracture 
Hospitalized for HF
Hospitalized for A fib 
Knee/hip replacement 
Major trauma 
MI within 3 months 
Previous VTE 
Spinal cord injury 

THROMBOSIS
Trauma/travel/ tachy(Afib)
Hospital/hormones
Relatives - factor V leiden
O-obese/obs
Malignancy
bone #- long bone
S- surgery and smoking
Immobilization
Sickness- nephrotic, APP, paroxysmal nocturnal hemoglobinuria 

Bed rest >3 days 
Air travel >6 hours 
DM
HTN 
Obesity 
>60 
Pregnancy 
Vericose veins 
Laparoscopic surgery 
Cancer
IBD
HRT
OCP
HF
Blood transfucsions 
MI
Previous VTE
A Fib
Major trauma 
Spinal cord injry

Question 3

What to do first if you think someone has a DVT

Answer 3

Wells score

Question 4

Wells for DVT

Answer 4

History:
Active cancer
Paralysis or casting of lower limb 
Recent surgery with bedridden in past 4 weeks 
Previous DVT 

Symptoms:
Localized tenderness along Deep vein system 
Swelling of the entire leg 
Calf swelling >3cm 
Pittin edema asymmetrically 
Collateral supervicial veins 

-2 if more likely to be something else

Question 5

Whats a concerning Wells

Answer 5

2 or more

Question 6

What to do with a concering wells

Answer 6

Ultrasound AND D Dimer

Question 7

What to do with a non concerning wells

Answer 7

Only D Dimer and if positive get an ultrasound

Question 8

How to we prevent DVT

Answer 8

Non pharm

• Early mobilization
• Compression with socks or pneumatics

Pharm:
LMHW

Question 9

How to treat a DVT

Answer 9

LMWH (Daltaparin) with overlap to warfarin for 5 days AND until INR is 2 for 2 days

DOAC/Xa inhibitors (Apixaban or Rivaroxaban) - Do double doses bid and then reduce

DOAC/Direct Thrombin (Dabigatran) (but only aver 5-10 days of LMWH because thrombin takes too long to work)

Can do just LMWH for cancer patients and pregnancy

Question 10

How long should they be on a treatment

Answer 10

3 months if provoked and provoking factor is gone

Forever if unprovoked

Question 11

How to diagnose upper arm DVT

Answer 11

CONSTANS score

Central line or pacemaker
Localized pain
Unilateral edema
Minus one if other dx

-1 or 0 just get a d dimer
1 + get untasound

Question 12

Lets say you’re rural and someone comes in with what you’re almost sure is a DVT
Ultrasound tech will come in tomorrow. What to do in the meantime

Answer 12

1 dose Apixaban or rivaroxaban (OAC Xa)

1 dose of LMWH daltaparin