DVT

Question 1

DVT overview

Answer 1

Common, potentially fatal
VTW in the circulation
Secondary to stagnation of blood and hyper-coagulable state
Travel to deep veins through right side of heart into lungs - into pulmonary arteries - PE

Question 2

Atrial septal defect and DVT

Answer 2

DVT can pass through left side of heart - can go to brain - large stroke

Question 3

RF for DVT

Answer 3

Question 4

Thrombophilias

Answer 4

Predispose patients to blood clots 
Antiphospholipid syndrome
Factor V Leiden
Antithrombin deficiency
Protein C or S deficiency
Hyperhomocysteinaemia
Prothrombin gene variant
Activated protein c resistance

• one cause of recurrent VTE = antiphospholipid syndrome

Question 5

• one cause of recurrent VTE = … syndrome

Answer 5

• one cause of recurrent VTE = antiphospholipid syndrome
  Also recurrent miscarriage
  Blood test for antibodies

Question 6

VTE prophylaxis

Answer 6

Every patient should be assessed when admitted
Increased risk = LMWH unless contraindicated
(Active bleeding, existing anticoag)
Anti-embolic compression stockings - contraindication include PAD

Question 7

Presentation of DVT

Answer 7

Unilateral almost always
Measure calf 10cm below tibial tuberosity in both calves - more than 3cm is key
Ask about PE symptoms

Question 8

Wells score

Answer 8

DVT/PE risk
Including risk factors
Online calculator to do this

Question 9

diagnosing DVT

Answer 9

D dimer - blood test that is sensitive but not specific
(95% will have a raised D dimer)
Doppler US to comfirm/diagnose DVT
+ D dimer - wells score = DVT likely

Question 10

Diagnose PE

Answer 10

CTPA - GOLD standard

VQ scan - contrast allergy/kidney impairment

Question 11

DVT initial management

Answer 11

Anticoagulation
Apixaban/rivaroxaban
Stop if excluded

Question 12

Long term anticoagulation for DVT/PE

Answer 12

DOAC - no monitoring, oral
Warfarin - INR monitoring, bit k antagonist (2-3 INR) first line in antiphospholipid syndrome
LMWH - first line in pregnancy

Question 13

LT anticoagulation

Answer 13

Continue for 3 months if clear reversible cause then review
Beyond 3 months if unclear cause, recurrent or irreversible cause (6 months)
3-6months in active cancer then review

Question 14

Inferior vena cava filter

Answer 14

Devices into IVC to filter the blood and catch clots from venous system towards heart and lungs
Sieve to allow blood to flow through
Used in usual cases of recurrent PEs, unsuitable for recurrent PEs/ unsuitable for anticoagu

Question 15

Unprovoked VTE

Answer 15

First VTE - no clear RF, consider whether it is triggered by cancer
NICE guidance - medical history, baseline bloods, physical exams
Unprovoked - not continuing long term anticoag - consider testing for antiphospholipid syndrome and consider testing for hereditary thrombophilias if first degree relative have DVT/PE