DVT and PE Flashcards
what is a DVT?
deep venous thrombosis
a thrombus that forms in the deep venous circulation
what is a PE?
pulmonary embolism
a thrombus that has embolised and lodged in the pulmonary circulation
what is VTE?
venous thromboembolic disease
covers DVT and PE
where does a distal DVT occur?
the calves
where do proximal DVTs occur?
popliteal or femoral vein
what three things make up virchow’s triad?
hypercoagulable states
endothelial injury
circulatory stasis
how does DVT present?
painful, swollen, red and hot limb
subacute
shiny leg
how does PE present?
sudden SOB with pleuritic chest pain may collapse haemoptysis hypoxia tachycardia hypotensive
what does a negative D-dimer mean when diagnosing DVT/PE?
rules it out - no clot
what does a positive D-dimer mean when diagnosing DVT/PE?
not diagnostic - tells you theres a clot but not where
what is D-dimer?
a breakdown product of cross linked fibrin
what is the initial investigation if a patient has a high probability of PE/DVT?
scan
what is the initial investigation if a patient is low risk for PE/DVT?
D-dimer
if this is high = scan
what is the best way to diagnose DVT?
USS
what is the best way to diagnose PE?
CTPA
what determines the severity of a PE?
how bad symptoms are or if it is proximal
what determines the severity of a PE?
PESI and patient characteristics
what does a low PESI score mean?
low mortality risk from PE
when does post thrombotic syndrome (PTS) occur?
within 5 years after an idiopathic DVT
what characterises PTS?
pain oedema hyperpigmentation eczema varicose veins venous ulceration
how is DVT managed?
oral anticoagulation
how is a high risk PE managed?
thrombolysis then oral anticoagulation
how is an intermediate/low risk PE managed?
oral anticoagulation
name two direct oral anticoagulants
apixiban
rivaroxaban
what is the first line anticoagulant for DVT/PE
direct oral anticoagulants (DOACS)
when is warfarin given for DVT/PE
only in patients with metallic heart valves
what is the MOA of warfarin?
vitamin K antagonist
how long should treatment be done for a provoked VTE with a reversible cause?
3-6 months
how long should treatment be done for a provoked VTE with an irreversible cause?
3-6 months OR lifelong depending on individual patient
how long should treatment be done for an unprovoked VTE?
long term
what scoring is used to determine when anticoagulation should be stopped after an unprovoked VTE in women?
HERDOO2
