DVT Flashcards
Risk factors
Immobility
Recent surgery
Long haul flight
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
SLE
Thrombophilia
Examples of thromophilias
Antiphospholipid syndrome
Factor V leiden
Antithrombin deficiency
Protein S or C deficiency
Activated protein C resistance
VTE prophylaxis
Usually low molecular weight heparin (enoxaparin)
Contraindications to VTE prophylaxis with heparin
Active bleeding or existing anticoagulation with warfarin or a DOAC
Contraindication for compression stockings
Peripheral artery disease
DVT presentation
Unilateral calf or leg swelling
Dilated superficial veins
Tenderness to the calf
Oedema
Colour changes to the leg
Wells score
Predicts risk of patient presenting with symptoms having a DVT or PE
Diagnosis
D-dimer sensitive (95%) but not specific
Doppler US (repeat if negative after 6-8 days if positive D-dimer and wells score likely)
PE diagnosis
CTPA (preferred) or VQ scan
Other causes of raised D-dimer
Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy
Initial DVT/PE management
Treatment dose apixaban or rivaroxaban immediately
Consider catheter directed thrombolysis in patients with symptomatic iliofemoral DVTand symptoms lasting less than 14 days
Long term anticoagulation
DOAC, warfarin or LMWH
3 months if reversible cause
> 3 months if cause unclear/ recurrent VTE or irreversible underlying cause e.g. thrombophilia
3-6 months in active cancer
DOACs
Anticoagulants that do not require monitoring
Apixaban, rivaroxaban, edoxaban, dabigatran
Warfarin
Vitamin K antagonist
(first line in patients with antiphospholipid syndrome)
Target INR for warfarin
Between 2 and 3 when treating DVTs and PEs
