DVT

Question 1

Risk factors for DVT?

Answer 1

THROMBOSIS
Trauma, thrombophilia
Hormonal (OCP, pregnancy, HRT)
Relatives (family history of DVT), or Recent surgery.
Old,
Malignancy,
Bone fractures
Obesity,
Smoking,
Immobilisation,
Sickness.

Question 2

Signs and symptoms of DVT?

Answer 2

Unilateral warm, swollen calf. If 3cm+ difference in calf circumference then likelihood increases.
Pain on palpation
Distention of superficial veins
Pitting oedema

Question 3

Investigations for DVT?

Answer 3

1st preform a 2-level wells score.

If scores >2 then perform an ultrasound doppler of prox leg veins within 4 hr. If cannot be done in 4h, get d-dimer while waiting, if positive then start treatment.

If scores 1 or less then perform d-dimer in 4hr. If cannot be done in 4h then start treatment while waiting. If +ve then move to ultrasound scan. If scan -ve but d-dimer positive then repeat scan in 1 week. if d-dimer -ve then consider alternative dx.

Question 4

Rx for DVT?

Answer 4

DOAC is first line, either apixiban or rivaroxiban.
If severe renal impairment (eGFR <15)t then use LMWH instead.
Treatment length for 3 months if provoked and 6 months if unprovoked.

Question 5

Complications of DVT?

Answer 5

PE
Heparin induced thrombocytopenia
Post thrombotic syndrome - chronic pain, swelling, skin discolouration, venous ulcers.