DVT

Question 1

What causes/are risk factors for DVT?

Answer 1

Older patients
1 in 1000 adults per year
Rare in children
Much more common in pregnancy

Common in immobile sedentary people but can also happen post operatively, post pregnancy, in people with cancer, being on oral contraceptives.

Question 2

How does DVT present?

Answer 2

Swollen, red, firm and warm leg due to retention of liquid – will appear larger than the other. Usually people will not have symptoms

Question 3

What scoring system is used to determine the likelihood of a DVT?

Answer 3

Wells Scoring system (only do if not pregnant otherwise refer immediately)
Score one for each point and minus two if an alternative cause is more likely
• Active cancer (treatment ongoing, within the last 6 months, or palliative).
• Paralysis, paresis, or recent plaster immobilization of the legs.
• Recently bedridden for 3 days or more, or major surgery within the last 12 weeks requiring general or local anaesthetics.
• Localized tenderness along the distribution of the deep venous system (such as the back of the calf).
• Entire leg is swollen.
• Calf swelling by more than 3 cm compared with the asymptomatic leg (measured 10 cm below the tibial tuberosity).
• Pitting oedema (greater than on the asymptomatic leg).
• Collateral superficial veins (non-varicose).
• Previously documented DVT.

DVT unlikely if score = 1 or less
DVT likely if score = 2 or more

Question 4

How should a patient be investigated if their Well’s score suggests a DVT is likely?

Answer 4

If DVT likely then:
Proximal leg ultrasound scan within 4 hours – if this can’t happen within 4 hours then do a blood test for D-Dimers (fibrin breakdown product indicating that fibrinolysis is actively taking place). This test is good at ruling out thrombotic disease but not good at determining there definitely is one.

Question 5

How should a patient be investigated if their well’s score suggests a DVT is unlikely?

Answer 5

If DVT unlikely do a d-dimer test and if this is +ve then do a proximal leg ultrasound scan.

Question 6

How is a DVT managed?

Answer 6

Usually managed prophylactically by giving patient SC enoxaparin on entry to hospital. After a DVT has happened patients should be given heparin unless this can’t be given in which case you should try thrombin inhibitors such as dabigatran.
After DVT has resolved the patients must remain on anticoagulant therapy for at least 3 months (duration of time dictated by specialists), usually a DOAC.

Ensure those who have an unprovoked incidence of DVT are tested for relevant cancers and thrombophilia.

Never give someone antiplatelet therapy alone in DVT or PE

Question 7

What complications can occur from a DVT?

Answer 7

Leg ulcers
Varicose veins
More serious in pregnancy
PE