DVT

Question 1

What are intrinsic RFs

Answer 1

1. prev DVT
2. cancer
3. older age
4. Obesity
5. HF
6. Male
7. Acquired familial thrombophilia
8. Chronic low grade injury to vascular wall e.g. vasculitis, hypoxia due to venous stasis, chemo

Question 2

What are temporary RFs

Answer 2

1. immobility
2. Significant/direct trauma to a vein e.g. cannula
3. Hormone Rx
4. Pregnancy + postpartum
5. Dehydration

Question 3

When would u suspect DVT? what are the typical signs/sx

Answer 3

1. If RFs present
2. Signs + sx:
   - pain + swelling in leg
   - tenderness
   - change in skin colour + temp
   - vein distension

Question 4

Describe the wells score for DVT

Answer 4

1. Active cancer - +1
2. Paralysis, paresis, or recent plaster immobilization of the lower extremity + 1
3. Bedridden recently >3 days or major surgery within 12 weeks - +1
4. Localized tenderness along the deep venous system - +1
5. Entire leg swollen - +1
6. Calf swelling >3cm compared to other leg - +1
7. Pitting oedema on sx leg - +1
8. Collateral superficial veins present
9. Prev DVT - +1
10. Alternative diagnosis to DVT as likely or more likely - -2

Question 5

What Wells score makes DVT likely and unlikely?

Answer 5

DVT likely ≥2

DVT unlikely ≤1

Question 6

How would you manage a pt w a Wells score of ≥2

Answer 6

Proximal leg vein US within 4 hours

If this cannot be carried out within 4 hours do D-dimer and administer LMWH whilst waiting for US

Question 7

How would u manage a pt w a Wells score of ≤1

Answer 7

perform D-dimer
if +ve do proximal leg vein US within 4hrs
if cannot do US, give LMWH whilst waiting

Question 8

What is the treatment of DVT

Answer 8

SAME AS PE

1. LMWH/FONDAPARINUX (within 24hrs)
2. Warfarin continued for 3m

Question 9

What are the DDs of DVT?

Answer 9

• Cellulitis
• CV disorders - superficial thrombophlebitis
• Physical trauma e.g. calf muscle tear
• Ruptured Baker’s cyst