DVT Flashcards
What % below knee DVT’s are asymptomatic and rarely embolize to the lung?
65%
Signs of DVT
Unilateral calf swelling erythema mild fever pitting oedema pain in foot/ankle lightheaded/dizzy and sudden fainting
Differentials for DVT
Cellulitis
Ruptured Baker’s cysts
both of these can coexist with DVT
How does Scoring become involved with investigations in DVT?
Well’s score
if <1 (DVT unlikely)
if >2 (DVT likely)
<1
do D-dimer:
-ve = exclude DVT
+ve = do USS, USS (+ve) Tx for DVT, if -ve then exclude DVT
> 2
do D-dimer + USS
if both +ve = Tx DVT
if both -ve = DVT excluded
if D-dimer +ve and USS -ve then repeat USS in one week
D-dimer = sensitive but not specific for DVT, - what else is it raised in?
Infection
Malignancy
Pregnancy
if there is no predisposing factors what test should you do before commencing anticoagulant therapy?
Thrombophilia
(inherited/acquired coagulopathy)
Look for underlying malignancy if they are below what age?
What tests would you do?
40
Urine dip
FBC, LFT, Ca2+
CXR +/- CT Abdo/pelvis
RF for DVT
Medical Hospitalisation Major surgery within last 3 months active cancer trauma to lower limbs obesity pregnancy
Prevention?
Stop OCP 4 weeks pre-op
LMWH for high risk patients
compression stockings
reduces risk of DVT over LMWH in major orthopaedic surgery?
Fondaparinux (Factor Xa inhibitor) - reduces risk of DVT over LMWH in major orthopaedic surgery
For long distance travel:
if someone has >1 RF?
if high risk and >6h flight?
compression stockings
consider single dose of LMWH for >6h flight.
Why are patients at risk during long distance travel?
dehydration
immobilisation
decreased oxygen tension
Tx of DVT?
in cancer patients?
LMWH or Fondaparinux
receive LMWH for 6 months (then review).
when do you start warfarin?
why>?
when do you stop the heparin
how long on warfarin?
same time as LMWH
prothrombotic for the first 48h
when INR is 2-3
3 months
new alternatives to warfarin.
DOAC’s - less bleeding risk,
simpler dosing and monitoring
