DVT Flashcards
what are the symptoms of DVT? 4
- pain in the calf, often with swelling, redness and engorged superficial veins
- tenderness
- mild fever
- pitting oedema
what investigations are done for DVT?
- d- dimer
- ultrasound
what is d- dimer?
a breakdown product of fibrin
D-dimer is ______ but not ____ for DVT (also in infection, pregnancy, malignancy, and post-op).
D-dimer is sensitive but not specific for DVT (also in infection, pregnancy, malignancy, and post-op).
If D-dimer, or the patient has a high/ intermediate pretest clinical probability score, do _______
If D-dimer, or the patient has a high/ intermediate pretest clinical probability score, do ultrasound.
If ultrasound is –ve, what is done
a repeat USS may be performed at 1wk to catch early but propagating DVTS.
what test should be done before anticoagulation therapy if there are no predisposing factors, in recurrent DVT, or if there is a family history of DVT. ?
thrombophilia tests
what does a wells score of
DVT unlikely
what should be done when the wells score is
perform D-dimer
if negative, DVT excluded
If positive, do USS - if USS negative , DVT excluded, if positive, treat as DVT
what does a Wells score of >2 points indicate>
DVT likely
what should be done if wells>2?
do d dimer and USS
if both negative exclude DVT
If USS positve treat as DVT
what other tests should be performed with DVT?
Look for underlying malignancy : Urine dip; FBC, LFT, Ca2+; CXR ± CT abdomen/pelvis (& mammography in ) if >40yrs.2
what steps could be taken to prevent DVT? 5
- Stop the pill 4wks pre-op
- mobilise early
- LMWH (e.g enoxaparin)
- graduated compresssion stockings
- fondaparinux
what is a downside of stockings?
they can compress arteries leading to ischaemia in some people
In general they are useful for people with no evidence of vascular disease
compression stockings should be worn for at least ___ years post thrombosis
2
what is fondaparinux?
a factor Xa inhibitor- reduces DVT risk over LMWH without increasing the risk of bleeding
Main treatment of DVT- see VTE
.
thrombolysis should be considered in patients with….
symptomatic ileofemoral DVT symptoms less than 14 days duration and:
good futioal status
a life expectancy of 1 year or more
a low risk of bleeding
who should temporary IVC filters be offered to?
patients with proximal DVT or PE who cannot have anticoagulation therapy
Consider IVC filter for patients with________ or ___ despite adequate anticoagulation only after considering increasing target___ or _____
recurrent proximal DVT or PE
INR or LMWH
IVC filters often cause___
complications
what are the complications of IVC?
they thrombose
