DVT

Question 1

Wells criteria

Answer 1

Active cancer
Paralysis or recent plaster cast
recent immobilization or major surgery
Tenderness along the deep veins
swelling of the whole leg
> 3 cm difference in calf circumference compared to the other leg
pitting edema
collateral superficial veins

Question 2

Scoring in Wells

Answer 2

Likely alternative diagnosis = - 2 points
score > 3 high pretest probability
score = 1 - 2 moderate probability
score < 0 low pretest probability

Question 3

Investigations

Answer 3

lower extremity venous US - moderate to high probability
D-dimer levels - low probability
- abnormal D-dimer - lower extremity US

Question 4

Treatment

Answer 4

1. Immediate-acting anticoagulant - unfractionated, LMWH
2. Warfarin initiated with heparin - with 4 - 5 days of overlap until INR is therapeutic (2-3) for 2 measurements taken 24 hours apart

Question 5

Length of treatment for 1st provoked episode

Answer 5

3 - 6 months

Question 6

Treatment for Factor V leiden heterozygotes

Answer 6

8x inc. relative risk - use anticoagulation @ times of inc risk

Question 7

Indications for IVC filter

Answer 7

cannot use anticoagulation - active cerebral bleed

clot extension at therapeutic level of anticoagulation

Question 8

Treatment for low recurrence risk

Answer 8

3 - 6 months

Question 9

Diagnosis of DVT with intermediate/high pretest probability of VTE

Answer 9

Low probability V/Q does not reasonably exclude PE:
- used D-dimer and Doppler
with + D-dimer and - Doppler - get pulmonary angiogram