DVT

Question 1

What is a DVT?

Answer 1

Formation of a blood clot in the deep veins of the leg or pelvis

Question 2

What is Virchow’s triad?

Answer 2

Hypercoagulability
Venous stasis
Endothelial damage

Question 3

What are the risk factors for DVT?

Answer 3

Age
Immobility
Trauma
Thrombophilia
Polycythemia
Malignancy
Smoking
Pregnancy
Drugs - COCP, HRT, tamoxifen

Question 4

What are the clinical features of DVT?

Answer 4

Unilateral calf or leg swelling
Dilated superficial veins
Calf tenderness
Oedema
Redness to the leg

Question 5

What is the Wells score for DVT?

Answer 5

Each criterion scores 1 point:
- Active cancer
- Bedridden or recent major surgery
- Calf swelling > 3cm compared to other leg
- Superficial veins present
- Entire leg swollen
- Tenderness along veins
- Pitting oedema of the affected leg
- Immobility of affected leg
- Previous DVT

-2 points for alternative diagnosis likely

Question 6

What are the first line investigations for DVT?

Answer 6

Wells score > 2
- Duplex ultrasound of leg
Wells score < 1
- D-dimer - perform an ultrasound if raised

Question 7

What are the possible causes of a raised D dimer?

Answer 7

Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy

Question 8

What is the initial management of a DVT?

Answer 8

First line - Offer apixaban or rivaroxaban
Second line - LMWH for 5 days, followed by dabigatran or edoxaban, or LMWH and warfarin for 5 days, and then warfarin alone

Question 9

How long should anticoagulation be continued for in patients with a DVT?

Answer 9

3 months

Question 10

What is the initial management of DVT in renal impairment?

Answer 10

LMWH
or
Unfractioned heparin
or
LWMH or UFH and warfarin for 5 days, and then warfarin alone

Question 11

How long should anticoagulation for DVT be continued in cancer patients?

Answer 11

3 to 6 months