DVT Flashcards
DDx lower extremity edema
DVT
Venous Insufficiency
Venous Obstruction (Baker’s Cyst, Mass, Position, Compression)
Lymphatic Obstruction
Compartment Syndrome
Trauma
Cellulitis
Allergic Reaction
Cirrhosis
Hypoalbuminuria (nephrotic, malnutrition, enteropathy)
Medications (CCBs, NSAIDs, Thiazolidinediones)
Pre-Eclampsia/Eclampsia
Myxedema
Lymphatic Filariasis
Eosinophilic Fasciitis
Congestive Heart Failure
Pericardial Effusion
Pericarditis
Valvular Issues (stenosis, regurgitation)
Pulmonary Hypertension
Cor Pulmonale
Most common thrombophilia causing DVT
Factor V Leiden
RF
Virchow’s triad: endothelial damage, venous stasis, hypercoagulability
Hospitalisation
Immobility
Trauma
Prev VTE
OCP
Postpartum
Pregnancy
Cancer
FDR
Complications
PE
Chronic venous insufficiency
Chronic venous insufficiency rx
exercise, compression stockings, leg raises
Chronic arterial insufficiency sx
Decreased Pulses, Loss of Hair, Hypertrophic Nails, Decreased Cap Refill, Rubor, Cool Skin, Arterial Ulcers
Acute arterial insufficiency sx
pale, pulseless, pain, paresthesia, polar, paralysis
DDx bilateral leg pain with activity
Arterial claudication
Neurogenic Claudication/Spinal Stenosis
Radiculopathy
Osteoarthritis
Popliteal Mass (Baker’s Cyst, Cancer, Trauma)
Varicose Veins
Deep Venous Thrombosis
Post Thrombotic Syndrome
Neuropathy (Diabetic, Peripheral)
Ix for claudication
ABPI
Doppler Ultrasound
CT Angiography
MR Angiography
Angiogram
What ABPI is abnormal, and when do you see rest pain?
<0.9
<0.3
Where do you see arterial ulcers on lower limb?
Lateral foot
Sx DVT
Unilateral edema, erythema, warmth, tenderness
Palpable cord
Ix
D dimer - for low risk Well’s score <2
US - for high risk Well’s score
Rx
LMWH or IV heparin for 5d + warfarin until INR >2
Apixaban 10mg PO BID x 7/7 then 5mg BID
What are the hypercoagulability syndromes causing DVT
Factor V leiden
Prothrombin
Protein C or S deficiency
Antithrombin defiency
Prophylaxis for DVT
Risk assess all hospitalised pts
Early ambulation
Compression stockings
Intermittent pneumatic compressions
LMWH for high risk (pregnant woman w/ >2 RF)
DDx for unilateral edema
Deep vein thrombosis
Venous insufficiency
Lymphedema
pretibial myxedema
When do you see brown hemosiderin deposits?
venous insufficiency
What is the Kaposi-Stemmer sign?
inability to pinch a fold of skin at dorsum proximal second toe is a sign of lymphedema
Post phlebitic syndrome rx
r/o DVT w/ duplex doppler US, compression stockings, elevation, exercise, topical meds for skin changes, refer for vein ablation excision, horse chestnut seed oil
What is the best way to investigate ?DVT?
Wells <2 = D Dimer, wells >2 = proximal leg compression US. If US negative in high risk person, do D dimer. If negative, do US again in few days time
RF for DVT
stasis, trauma (recent central line, pacemaker, surgery), hypercoagulable states (cancer, pregnancy, meds (hormonal), IBD, CHF, nephrotic syndrome, thrombophilia)
When to test for thrombophilia in DVT?
Fam hx of clots, young, multiple/ recurrent
Upper arm DVT diagnostic score
CONSTANS: central line/ pacemaker, localised pain, unilateral edema, other diagnosis plausible
When to Rx while awaiting US for DVT?
If US is delayed, mod-high suspicion, no CI
How to rx DVT if US delayed
1 dose oral Xa inhibitor or 1 dose of LMWH
When to give heparin as a bridge in DVT?
Direct thrombin inhibitor or warfarin
Rivaroxaban class
factor 10a
Dabigatran class
direct thrombin inhibitor
