DVT

Question 1

2 level DVT Wells score

Answer 1

DVT score

1 point :
Cancer
Paralysis
Major surgery 12 weeks
Localized tenderness
Entire leg swollen
Calf swelling 3cm or more
Pitting oedema
Collateral superficial
Previous DVT
Possible alternative diagnosis -2 points

2 or more points - DVT likely

Question 2

Likely DVT (>=2 p. Wells score)

Answer 2

1. DUS within 4 hours.
   If negative ->D-Dimer (if d dimer positive stop ANTICOAGULATION, repeat scan in 6-8 days)

If longer than 4 hours-> D-Dimer, ANTICOAGULATION, DUs 24h

If positive
-ANTICOAGULATION (if contraindicated -intervention)

Question 3

DVT unlikely Wells <1

Answer 3

D-Dimer 4 hours
If not available - ANTICOAGULATION until result available

If positive - DUS

Question 4

Skala wellsa

Answer 4

Prawdopodobieństwo DVT i PE

Question 5

Two level PE wells score

Answer 5

More than 4 points - PE likely

DVT 3 points

Alternative diagnosis less likely 3 points

HR > 100 1,5 points

Immobilization for more than 3 days
or surgery in last month 1,5 points

Previous DVT 1,5 points

Haematoptysis 1

Malignancy 1

Question 6

PE likely in wells score

Answer 6

CTPA

Jeśli ct niedostępne- ANTICOAGULATION

Question 7

Postępowanie przy potwierdzonym PE

Answer 7

1. ANTICOAGULATION
2. IF contraindicated - mechanical intervention
3. Haemodynamic instability- thrombolytic therapy

Question 8

PE unlikely - wells score= <4

Answer 8

D dimer if positive CT

Question 9

Minimal time of ANTICOAGULATION in DVT or PE

Answer 9

3 months

Question 10

Leki z wyboru w PE i DVT wg NICE

Answer 10

Rivaroxaban
Apixaban

Question 11

If apixaban and rivaroxaban in PE/DVT are not suitable

Answer 11

LMWH for at least 5 days followed by dabigatran or edoxaban or

• LMWH concurrently with a vitamin K antagonist (VKA) for at least 5 days, or until the INR is at least 2.0 in 2 consecutive readings, followed by a VKA on its own. [2020]

Question 12

Anticoagulation treatment for DVT or PE in people at extremes of body weight

Answer 12

1.3.11 Consider anticoagulation treatment with regular monitoring of therapeutic levels for people with confirmed proximal DVT or PE who weigh less than 50 kg or more than 120 kg, to ensure effective anticoagulation.

Question 13

Anticoagulation treatment for PE with haemodynamic instability

Answer 13

For people with confirmed PE and haemodynamic instability, offer continuous
UFH infusion and consider thrombolytic therapy

Question 14

Leczenie PE/DVT w niewydolności nerek

Answer 14

eGFR 15-50 ml/min
Wszystkie leki jak u zdrowych, w dawkach dostosowanych

eGFR < 15 ml/min

LMWH
UFH

Heparynę łącznie z VKA przez min 5 dni albo do czasu kiedy INR w dwóch kolejnych pomiarach wynosi min 2

Question 15

ANTICOAGULATION in DVT/PE with active cancer

Answer 15

3-6 months
DOAC/ LMWH/ VKA

Question 16

Treatment failure

Answer 16

• check adherence to anticoagulation treatment
• address other sources of hypercoagulability

Increase dose or change

Question 17

Tromboliza w DVT

Answer 17

Catheter directed
• symptoms lasting less than 14 days and
• good functional status and
• a life expectancy of 1 year or more and
• a low risk of bleeding. [2012]

Question 18

Tromboliza w PE (systemic)

Answer 18

Haemodynamic instability

Question 19

Inferior vena caval filters in DVT / PE

Answer 19

Anticoagulation is contraindicated or a PE has occurred during anticoagulation reatment

Question 20

Pończochy w prewencji zespołu pozakrzepowego

Answer 20

Nie

Question 21

Cancer in unprovoked DVT

Answer 21

Nie szukaj o ile nie mają innych objawow

Question 22

Thrombophilia testing

Answer 22

Consider testing - for antiphospholypid antibodies- unprovoked DVT- plan to stop ANTICOAGULATION

Do not offer testing for hereditary thrombophilia to people who are continuing anticoagulation treatment.

Unprovoked DVT

Question 23

ATTRACT trial

Answer 23

pharmacomechanical catheter–directed thrombolysis (PCDT) did not prevent postthrombotic syndrome (PTS) in patients with acute proximal deep vein thrombosis.

Question 24

In patients with acute iliofemoral deep vein thrombosis, PCDT ….

Answer 24

did not
-influence the occurrence of PTS -recurrent venous thromboembolism.

significantly reduced
-early leg symptoms and,
-over 24 months, reduced PTS severity scores,
-reduced the proportion of patients who developed moderate-or-severe PTS,
-and resulted in greater improvement in venous disease– specific quality of life.

Question 25

Villata scale

Answer 25

Panel 2: Villalta scale for assessment of post-syndrome (PTS) 15,26
Five patient-rated venous symptoms
• Pain
• Cramps
• Heaviness
• Paraesthesia
• Pruritus

Six clinician-rated signs
• Pretibial oedema
• Skin induration
• Hyperpigmentation
• Pain during calf compression
• Venous ectasia
• Redness

Scoring
Each sign or symptom is rated as 0 (none), 1 (mild), 2 (moderate), or 3 (severe), and summed to produce a total score. A total score of less than 5 indicates no PTS, of 5-14 indicates mild or moderate PTS, and of 15 or more (or presence of venous ulcer) indicates severe PTS.

Question 26

Hypercoagulable disorders to test for in
VTOS

Answer 26

Inherited
Factor V Leiden/activated protein C resistance
Factor II (prothrombin
G20210) polymorphism
Protein C deficiency
Protein S deficiency
Antithrombin deficiency
Hyperhomocysteinemia

Acquired
Antiphospholipid antibody syndrome
Anticardiolipin antibodies
Anti-beta-2 glycoprotein antibodies
Lupus anticoagulant