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Acute Medicine > DVT > Flashcards

DVT Flashcards

1
Q

How does swelling occur in DVT?

A

increased hydrostatic pressure within veins by obstruction
consequent back pressure raises capillary hydrostatic pressure
causes fluid to move out into tissues

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2
Q

What does fluid movement depend on?

A

balance between net oncotic and net hydrostatic pressures

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3
Q

What are the signs of DVT?

A 
calf warmth
tenderness
swelling
erythema
mild fever
pitting oedema
vein distension
unilateral localised pain
Homan's sign
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4
Q

What is Homan’s sign?

A

discomfort behind the knee on forced dorsiflexion of the foor

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5
Q

What are the risk factors of DVT?

A 
age
trauma
surgery
Hx of DVT/PE
obesity
heart failure
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6
Q

What are the investigations for DVT?

A

USS doppler
? underlying malignancy
thrombophilia screen

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7
Q

What scoring system is used for suspected DVT?

A

Wells score (2+ points)

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8
Q

How soon should a doppler of the proximal leg vein be performed?

A

within 4 hours

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9
Q

What is a doppler is not possible?

A

within 4 hours:
D-dimer
interim therapeutic anti-coagulation
proximal leg vein ultrasound

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10
Q

What are first line anti-coagulation for DVT?

A

apixaban/rivaroxiban

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11
Q

What is second line for DVT?

A

LMWH for 5 days followed by dabigatran/edoxaban

or LMWH with vitamin K antagonist

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12
Q

What tests need to be carried out alongside anticoagulation?

A

FBP
U&E
LFTs

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13
Q

What is the duration of treatment for DVT?

A

3 months

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14
Q

How long should treatment for DVT be for cancer patients?

A

6 months

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15
Q

If no cause is identified for DVT how long should treatment be?

A

6 months

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16
Q

What is the target for INR?

A

2-3

17
Q

What are surgical options for DVT when anticoagulants fail or active bleeding occurs/contraindications?

A

inferior vena cava filters

percutaneous thrombectomy

18
Q

If the DVT is unprovoked, what is the patient screened for?

A

cancer

thrombophilia

19
Q

What are teh complications of DVT?

A

PE
cardiac arrest
post-thrombotic syndrome

20
Q

What are the investigations for suspected DVT?

A

antiphospholipid Abs

21
Q

What are the 3 areas of Virchows triad?

A

stasis of blood flow
hypercoagubility
endothelial injruy

22
Q

What is the prevention for DVT?

A 
stop combined OCP 4 weeks pre-op
mobilise early during admission
LMWH  for high risk patients after VTE assessment
compression stockings
intermittent pneumatic compression
23
Q

What are post-thrombotic syndrome symptoms?

A 
chronic leg swelling
stiffness 
pain
tingling
cramps
leg ulcers

Acute Medicine (2 decks)

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