DVT

Question 1

what is a DVT. signs, symptoms, risk factors.

Answer 1

a clot in a vein deep to the muscular tissue planes. increases risk of PE by 50% + post thrombotic syndrome (paining).

S+S- calf swelling, pain along deep venous system. presence of risk factors, +ve wells score. prominent superficial veins.

active cancer, trauma, major surgery, hospitalisation, immobilisation, pregnancy, or oral contraceptive use. DVT may also be unprovoked (idiopathic)

Question 2

investigation and treatment of DVT

Answer 2

D-Dimer level. venous ultrasound, FBC(for anticoag baseline), urea and creatinine, LFT(baseline), clotting screen.

if unprovoked then review medical history + B/L bloods. don’t investigate for Ca unless indication to.

Rx: 3moths DOAC- no loading required
if on warfarin- loading dose is required.
LWMH if pregnant (does not cross placenta)

if recurrent- extended anticoagulation or IVC filter

consider compression stockings.

Question 3

what are the sections for wells score

Answer 3

Active cancer (treatment ongoing or within the previous six months or palliative) (1 point)

Paralysis, paresis, or recent plaster immobilization of the lower extremities (1 point)

Recently bedridden for more than three days or major surgery within four weeks (1 point)

Localized tenderness along the distribution of the deep venous system (1 point)

Entire leg swollen (1 point)

Calf swelling by more than 3 cm when compared with the asymptomatic leg (measured below tibial tuberosity) (1 point)

Pitting edema (greater in the symptomatic leg) (1 point)

Collateral superficial veins (nonvaricose) (1 point)

Alternative diagnosis as likely or more likely than that of DVT (-2 points)

Previously documented DVT (1 point)

2-9 points- likely
-2 to 1 point- unlikely.

Question 4

what is Virchow’s triad and how do they relate clinical

Answer 4

venous stasis- immobility, congestive heart failure etc

endothelial injury- surgery and trauma

hypercoagulability- OCP, Cancer, thrombophilia

Question 5

discuss DVT prophylaxis

Answer 5

Stratify into low med and high
low- young, no risk factors, no need for vte

med- at least 1 risk factor, pharmacological prophylaxis is preferred +/- mechanical

high- multiple risk factors- pharm + mechanical prophylaxis