DVT Flashcards
vte
venous thromboembolic disease
dvt
deep vein thrombosis - a thrombus formed in the deep venous circulation but can be anywhere
>clots form via venous valve pockets and other sites of presumed stasis
pe
a clot that has embossed and lodged in the pulmonary circulation
>clot travels through the right side of the heart to block vessels in the lungs
left side of the heart = arterial circulation
right side = venous circulation ie pulmonary arteries
DVT - proximal !
distal = dvt of calves proximal = dvt of popliteal vein or femoral vein (closer to the heart)
quality of life
have significant worse perceptions of their health
> lower levels of physical functioning
what is post thrombotic syndrome
30% people have it after proximal DVT
virchow’s triad
endothelial injury - venous disorders venous valvular damage trauma or surgery indwelling catheters hypercoaguable state - malignancy pregnancy and permpartum period oestrogen therapy inflammatory bowel disease sepsis thrombophilia circulatory stasis - LV dysfunction etc
risk factors for vte
> surgery , trauma , acute medical illness , acute heart failure
> ageing
> smoking ! travel , combined oral contraception , hormone replacement , protein C/S deficiency
factor V leiden mutation , pregnancy , active malignancy , surgeries , prothrombin gene mutation
how does vte present
dvt - painful and swollen limb with redness and heat
tenderness along vein subacute development - no other obvious cause
pe -
pre test probability
how likely is it that the patient will have what you’re looking for
>there are scoring systems
>mod/high scoring then dvt likely so go straight to scan (ie no d-dimer)
d-dimer blood test and vte
d-dimer is fibrin that has broken down
>high negative prediction values >98% for VTE
>low positive predictive value for vte
>valuable first line screening test for suspected VTE with low wells score
>25%-50% patients require no further investigations
severity assessment - pe
pesi score + patient characteristics
because PEs can cause rh strain and pressure there can be risk of deterioration and death
severity assessment guides initial management
dvt - severity assessment
clinical assessment of severity - almost all patients are managed as out patients
management of dvt
oral anti coagulation ie thrombolysis
sometimes thrombolysis
management of pe
thrombolysis the oral anticoagulants if high risk
low / med risk = oral anticoagulants
what is thrombolysis
fibrinolysis ie aggressive clot destruction
which anticoagulants
DOA = apodaban or rivaroxaban (these are the main ones - first line)
vit. K antagonist = warfarin
LMWH injections = still used in patients with active cancer and PE
duration of treatment
provoked vte with reversible factor = 3-6 months
“ with irreversible factor = 3-6 months or life long depending on patients
unprovoked vte =
post thrombotic syndrome
occurs in nearly 1/3 of patients within 5 years after dvt -PTS is characterised by : pain oedema hyperpigmentation eczema varicose collateral veins venous ulceration
CTEPH
serious complication of pe
5% get it after pe
initially asymptomatic and following progressive dyspnea and hyperaemia
RHF can frequently occur
progressive condition
… not the lungs but sort of cor pulmonale