DVT and PE

Question 1

Virchow’s triad?

Answer 1

Endotheilial wall damage
Changes in blood constituents
Stasis of blood

Question 2

What does venous thrombosis result in?

Answer 2

Back pressure of blood
DVT, PE

Question 3

What are the components of arterial vs venous thrombosis?

Answer 3

Arterial: ‘white thrombus’ plateletes and fibrin

Venous: ‘red thrombus’ red blood cells and fibrin

Question 4

How is venous thromboembolism prevented in hospital?

Answer 4

Early mobilisation
‘Anti-embolism stockings’
Other mechanical methods of thromboprophylaxis
Pharmacological thromboprophylaxis

Question 5

Symptoms and signs of dvt?

Answer 5

Unilateral limb swelling
Persisting discomfort
Calf tenderness

[Warmth]
[Redness- erythema]
[Prominent collateral veins]
[Unilateral pitting oedema]

May be clinically silent

Question 6

Diagnosis of dvt?

Answer 6

Clinical assessment and pretest probability score (Wells score)

Blood test: D-dimer if low pre-test probability score

Imaging: Compression ultrasound if positive D-dimer or high pre-test probability score

Question 7

What is a d-dimer?

Answer 7

Breakdown product of cross-linked fibrin
Produced during fibrinolysis

High sensitivity for VTE

Low specificity for VTE
Trauma, malignancy, sepsis, bleeding, cancer, recent surgery

Question 8

Symptoms and Signs of PE?

Answer 8

Pleuritic chest pain
Breathlessness- dyspnoea
[Blood in sputum- haemoptysis]
Rapid heart rate- tachycardia
Pleural rub on auscultation
usually due to pulmonary infarction

Question 9

Symptoms and signs of massive PE?

Answer 9

Severe dyspnoea of sudden onset
Collapse
Blue lips and tongue - cyanosis
Tachycardia
Low blood pressure
Raised jugular venous pressure
May cause sudden death

Question 10

Diagnosis of PE?

Answer 10

Clinical assessment and pretest probability score (Wells score or Geneva score)
Blood test: D-dimer if low pre test probability score
Imaging: if D-dimer positive or high pre test probability score
Isotope ventilation/perfusion scan
CT pulmonary angiogram

Question 11

PE treatment?

Answer 11

Anticoagulation is main treatment
Provoked – 3/12
Unprovoked and high risk of recurrence- Lifelong

Parenteral: Low molecular weight heparin (dalteparin) don’t use with kidney disease

Enteral: DOAC, rivaroxaban or warfarin

Question 12

Treatment for massive PE, DVT?

Answer 12

Surgical removal in dvt

Thrombolysis in PE

Question 13

Potential long-term consequences of DVT?

Answer 13

Post Thrombotic Syndrome
Damage to venous valves
Incidence of 20-60% within 2 years of DVT

Swelling
Discomfort
Pigmentation
Ulceration in severe form

Question 14

Potential long term consequences of PE?

Answer 14

Most recover fully
Pulmonary arterial hypertension
Serious outcome
4% patients (< 1/20)