DVT

Question 1

if a DVT is likely what is the first line investigation?

Answer 1

duplex USS (within 4 hours)

Question 2

describe the assessment of a patient with a suspected DVT.

Answer 2

Wells score

• DVT likely if > 2
• DVT unlikely if 1 or less

if likely;

• Dupplex USS within 4 hours
• if positive - treat accordingly
• if negative arrange d-dimer

if unlikely;

• d-dimer test
• if positive arrange duplex USS within 4 hours
• if negative get alternative diagnosis

Question 3

if a DVT was likely on the Wells score however a duplex USS was not available within 4 hours, what would you do?

Answer 3

perform D-dimer and give anticoagulants whilst awaiting d-dimer which should be performed within 24 hours

Question 4

what would you do if the d-dimer was positive but the duplex was negative?

Answer 4

stop anticoagulation

offer a proximal leg vein USS 6-8 days later

Question 5

what are causes of elevated d-dimer?

Answer 5

DVT, PE 
cancer 
infection 
DIC 
pregnancy 
pre-eclampsia 
recent trauma 
recent surgery 
kidney disease

Question 6

what is 1st line treatment of DVT?

Answer 6

DOAC e.g. Apixiban or Rivaroxiban

Question 7

what is 1st line treatment for DVT in a patient with severe renal impairment (< 15/min) ?

Answer 7

LMWH, unfractionated heparin or LMWH followed by warfarin

Question 8

how long is anticoagulation therapy continued in patients who have had a DVT?

Answer 8

if provoked then continue for 3 months

if unprovoked then continue for 3-6 months

Question 9

when assessing how long a patient should be on anticoagulants, what can be used to assess the patients risk of bleeding?

Answer 9

HAS-BLED score