DVT

Question 1

What are the three factors involved in the formation of a thrombus

Answer 1

1. abnormal flow - most common underlyig cause for a DVT
2. Abnormal constituents of blood e.g. smoking
3. abnormal vessel wall - atheroma, inflammatory response, direct trauma

Question 2

Which scoring system is used to assess risk of DVT and what are the risk factors

Answer 2

Wells Score

• Active Cancer
• Major surgery within last 12 weeks
• immobility of lower limbs
• previous DVT

Question 3

What are the main risk factors for developing a DVT (but not part of wells score)

Answer 3

Pregnancy/post partum
history of cancer 
Known thrombophilia disorder e.g. antiphospholipid syndrome 
Recent surgery 
Increasing age 
History of VTE 
Smoking 
Prolonged immobility 
Hormone replacement therapy or COCP
Obesity

Question 4

What are the clinical features of a DVT

Answer 4

unilateral calf swelling and leg pain 
May have 
pyrexia 
pitting oedema 
tenderness or prominent superficial veins 

HOWEVER 65% of DVTs are asymptomatic

Question 5

What does a wells score less than or equal to 1 suggest and what do you do

Answer 5

DVT is clinically unlikely and requires d-dimer to exclude

Question 6

What does a wells score greater than 1 suggest and what should be done

Answer 6

DVT is clinically likely and diagnosis should be confirmed via
Doppler ultrasound or contrast venography

Question 7

How is a DVT managed

Answer 7

Therapeutic dose of LMWH (1.5mg/kg/24hrs)
with warfarin started concurrently
LMWH is stopped after 5 days and waarfarin is continued for 6 months if no underlying cause found
NOACs may be used instead of warfarin e.g. rivoroxaban

Question 8

What are the differentials for a unilateral swollen calf

Answer 8

Compartment syndrome - passive stretch of the muscles causes pain, pain is out of proportion 
Cellulitis 
Trauma to calf
Haematoma 
Thrombophlebitis 
Ruptured bakers cyst