DVT

Question 1

What is a thrombus?

Answer 1

Solid mass formed in the circulation from the constituents of the blood during life

Question 2

What are the differences between venous and arterial thrombosis?

Answer 2

• Venous: low pressure, fibrin rich.

- Arterial: high pressure, platelet rich

Question 3

What are the 3 pillars of virchow’s triad?

Answer 3

1. Hypercoagulability (blood)
2. Vascular damage (vessel)
3. Circulatory stasis (flow)

Question 4

What are the risk factors for DVT?

Answer 4

1. Recent surgery
2. Immobility
3. Long haul flights
4. Pregnancy
5. HRT/ OCP
6. Polycythemia
7. Thrombophilia

Question 5

What is Thrombophilia?

Answer 5

Predisposition to developing blood clots. E.g anti- phospholipid syndrome, anti thrombin defeicinecy

Question 6

What is VTE prophylaxis?

Answer 6

Treatment given if the patient is at risk of developing a venous thromboembolism e.g low molecular weight heparin or compression stockings

Question 7

How does a DVT present?

Answer 7

• Unilateral
• Calf or leg swelling
• Dilated superficial veins
• Tenderness to the calf
• Oedema
• Changes in colour in the skin of the leg
• Can measure for more than a 3cm difference between the two calfs

Question 8

What other things do you need to be thinking of it a patient presents with a DVT?

Answer 8

PE (are they having SOB, chest pains and what’s their O2 sat like)

Question 9

What is the wells score?

Answer 9

Predicts the risk of a patient presenting with symptoms actually having a DVT or a PE. Takes into account risk factors and clinical presentation.

Question 10

What is a D dimer test?

Answer 10

Blood test which is almost always raised when there is a DVT. Measures the amount of fibrin break down which implies clotting

Question 11

Why is a D-dimer test not diagnostic of DVT?

Answer 11

Raised D-dimer just indicated cross linked fibrin that has been broken down. It is used for a negative exclusion test (ie if negative then NOT DVT). but if positive could be due to other things eg pregnancy, trauma, malignancy

Question 12

What is the gold standard test for a DVT?

Answer 12

Ultrasound dobbler

Question 13

What can be used to diagnose a PE?

Answer 13

Angiography or CT or a VQ scan

Question 14

What prevention methods would you use for DVT?

Answer 14

• Stop OC pill 4 weeks before surgery
• Mobilize early after surgery
• LMW heparin (eg enoxaparin 20 mg/24 h s/c)

Question 15

What pharmacological treatments can be used in management of a DVT?

Answer 15

• LMWH
• Wafarin
• DOAC

Question 16

How does warfarin work?

Answer 16

It is a vitamin K antagonist, which is essential in developing blood clots.

Question 17

What is the target INR for warfarin use?

Answer 17

2-3

Question 18

What are DOAC?

Answer 18

Oral anticoagulants that are not warfarin. They don’t require monitoring in the same way that warfarin does.

Question 19

What does DOAC stand for?

Answer 19

Direct oral anti-coagulants

Question 20

What would be the first line choice of treatment for DT in pregnancy or cancer?

Answer 20

Long term LMWH use

Question 21

What is non-pharmacological treatment for DVT?

Answer 21

Compression stockings

Question 22

What is Budd-Chiari Syndrome?

Answer 22

Budd-Chiari syndrome is where a blood clot (thrombosis) develops in the hepatic vein, blocking the outflow of blood. It is associated with hyper-coagulable states. It causes an acute hepatitis.

Question 23

What is the classic triad of symptoms in Budd-Chiari syndrome?

Answer 23

• Abdominal pain
• Hepatomegaly
• Ascites