DVT Flashcards
What are the risk factors for DVT?
THROMBOSIS:
Thrombophilia
Hormonal (COCP, pregnancy and the postpartum period, HRT)
Relatives (family history of VTE)
Older age (>60)
Malignancy
Bone fractures
Obesity
Smoking
Immobilisation (long-distance travel, recent surgery or trauma)
Sickness
What is the presentation of DVT?
Unilateral erythema warm and swelling
Pain on palpation of deep veins
Distention of superficial veins
How is DVT measured on calf?
It can be differentiated from deep vein thrombosis (DVT) by the presence of a tender, and indurated superficial venous segment
Palpation of DVT is confined to calf muscles
What is the Well’s scoring system?
Risk factors:
Active cancer (treatment within the last 6 months or palliative)
Paralysis, paresis, or recent plaster immobilisation of the legs
Recently bedridden for 3 days or more, or major surgery within the last 12 weeks
Physical features:
Localised tenderness along the distribution of the deep venous system
Entire leg is swollen.
Calf swelling at least 3 cm larger than asymptomatic side
Pitting oedema confined to the symptomatic leg
Collateral superficial veins
Personal history of DVT
When do you deduct 2 points from well score?
Alternative cause is at least as likely as a DVT
What should be done for Well’s score of 1 or less?
DVT is unlikely and a D-dimer should be sent
If the results cannot be obtained within 4 hours, offer interim anticoagulation whilst awaiting results
What should be done if D-dimmer is positive?
Ultrasound Doppler of proximal leg veins
What should be done for Well’s score of 2 or more points?
DVT is likely and an ultrasound doppler of the proximal leg veins should be done within 4 hours
What is the first line management of DVT?
DOACs like apixaban and rivaroxaban
What are second line options for DVT?
LMWH for 5 days with dabigatran or edoxaban
What should be tested for unprovoked DBT?
consider testing for thrombophilia with antiphospholipid antibodies in patients who are stopping anticoagulation
What prophylaxis for DVT should patients undergoing elective therapy receive?
Mechanical compression with a pneumatic compression device
Pharmacological with low molecular weight heparin 12 HOURS AFTER OPERATION
When is unfractionated heparin given rather than LMWH?
POOR renal function
What is the difference between unfractionated and LMWH?
Unfractionated is standard heparin which works acutely
LMWH has a longer duration of action
What is superficial thrombophlebitis?
Superficial thrombophlebitis refers to the inflammation of superficial veins, often caused by a venous thromboembolism
How can superficial thrombophlebitis be differentiated from DVT?
It can be differentiated from deep vein thrombosis (DVT) by the presence of a tender, and indurated superficial venous segment
Palpation of DVT is confined to calf muscels
Which condition can predispose patients to venous thromboembolic events?
Nephrotic syndrome due to loss of proteins like antithrombin III from hypoalbuminaemia
