DVT and PE

Question 1

what is a DVT?

Answer 1

deep venous thrombosis

a thrombus that forms in the deep venous circulation

Question 2

what is a PE?

Answer 2

pulmonary embolism

a thrombus that has embolised and lodged in the pulmonary circulation

Question 3

what is VTE?

Answer 3

venous thromboembolic disease

covers DVT and PE

Question 4

where does a distal DVT occur?

Answer 4

the calves

Question 5

where do proximal DVTs occur?

Answer 5

popliteal or femoral vein

Question 6

what three things make up virchow’s triad?

Answer 6

hypercoagulable states
endothelial injury
circulatory stasis

Question 7

how does DVT present?

Answer 7

painful, swollen, red and hot limb
subacute
shiny leg

Question 8

how does PE present?

Answer 8

sudden SOB with pleuritic chest pain
may collapse 
haemoptysis 
hypoxia 
tachycardia 
hypotensive

Question 9

what does a negative D-dimer mean when diagnosing DVT/PE?

Answer 9

rules it out - no clot

Question 10

what does a positive D-dimer mean when diagnosing DVT/PE?

Answer 10

not diagnostic - tells you theres a clot but not where

Question 11

what is D-dimer?

Answer 11

a breakdown product of cross linked fibrin

Question 12

what is the initial investigation if a patient has a high probability of PE/DVT?

Answer 12

scan

Question 13

what is the initial investigation if a patient is low risk for PE/DVT?

Answer 13

D-dimer

if this is high = scan

Question 14

what is the best way to diagnose DVT?

Answer 14

USS

Question 15

what is the best way to diagnose PE?

Answer 15

CTPA

Question 16

what determines the severity of a PE?

Answer 16

how bad symptoms are or if it is proximal

Question 17

what determines the severity of a PE?

Answer 17

PESI and patient characteristics

Question 18

what does a low PESI score mean?

Answer 18

low mortality risk from PE

Question 19

when does post thrombotic syndrome (PTS) occur?

Answer 19

within 5 years after an idiopathic DVT

Question 20

what characterises PTS?

Answer 20

pain
oedema 
hyperpigmentation 
eczema 
varicose veins 
venous ulceration

Question 21

how is DVT managed?

Answer 21

oral anticoagulation

Question 22

how is a high risk PE managed?

Answer 22

thrombolysis then oral anticoagulation

Question 23

how is an intermediate/low risk PE managed?

Answer 23

oral anticoagulation

Question 24

name two direct oral anticoagulants

Answer 24

apixiban

rivaroxaban

Question 25

what is the first line anticoagulant for DVT/PE

Answer 25

direct oral anticoagulants (DOACS)

Question 26

when is warfarin given for DVT/PE

Answer 26

only in patients with metallic heart valves

Question 27

what is the MOA of warfarin?

Answer 27

vitamin K antagonist

Question 28

how long should treatment be done for a provoked VTE with a reversible cause?

Answer 28

3-6 months

Question 29

how long should treatment be done for a provoked VTE with an irreversible cause?

Answer 29

3-6 months OR lifelong depending on individual patient

Question 30

how long should treatment be done for an unprovoked VTE?

Answer 30

long term

Question 31

what scoring is used to determine when anticoagulation should be stopped after an unprovoked VTE in women?

Answer 31

HERDOO2