DVT Flashcards
What is DVT
When a thrombus(clot) forms in the deep venous circulation usually legs
Aetiology
Virchow’s triad: Endothelial injury, Hypercoagulable state & circulatory stasis
What causes endothelial injury in Virchow’s triad
Indwelling catheters
Trauma or surgery
Venous valvular damage
Venous disorders
What causes a hypercoagulable state in Virchow’s triad
Pregnancy & peripartum
Malignancy
Thrombophilia (increased clot risk)
IBD
Sepsis
Oestrogen therapy
What causes circulatory stasis in Virchow’s triad
Left ventricular dysfunction
Immobility & paralysis
Venous insufficiency - varicose veins
Venous obstruction- tumour, pregnancy, obesity
Pathophysiology of DVT
DVT’s form predominantly in venous valve pockets & other sites of assumed stasis
What are the types of DVT
Distal - forms clot in calves
Proximal - Forms in popliteal/femoral vein (more likely to embolise)
Symptoms & signs of DVT
Mild fever
In calve = warmth, tender, swelling, red
Pitting oedema
Investigations
D-dimer test (identifies clotting problem) used if wells score is below 2 = unlikely to have DVT
US Doppler leg scan is diagnostic - used when >2 wells score or high d-dimer
Pharmacological acute management of DVT
Anticoagulation
1st line = apixaban or rivaroxaban (DOACs)
If neither apixaban or rivaroxaban are suitable for DVT treatment what should be given
LMWH (low molecular weight heparin) followed by either:
1. dabigatran or Edoxaban
2. Vitamin K antagonist like warfarin
Secondary pharmacological prevention of DVT
Anticoagulation = warfarin, DOAC or LMWH (low molecular weight heparin) -
Treatment should last at least 3 months e.g. provoked DVT with irreversible factors 3-6moths to lifelong
