DVT and PE Flashcards
DVT or PE risk factors
Stasis
-immobilisation, long haul flights
-varicose veins
Endothelial damage
-HTN, smoking, obesity
-vasculitis, sepsis
Hypercoagulability
-malignancy
-OCP/HRT, pregnancy
-past DVT
DVT
investigations and diagnosis
DVT likely => Leg vein US in 4hrs
-if not possible in 4hrs, do within 24hrs
-DD and interim DOAC
US :) => DOAC
US :( => DD
DD :) => stop interim DOAC, US repeat in 1wk
DD :( => alt diagnosis
DVT unlikely => DD in 4hrs
-if not possible, interim DOAC until it is
DD :) => US within 4hrs, interim DOAC
-if not possible, within 24hrs
DD :( => alt diagnosis
PE
-presentation
More commonly presents with atypical symptoms
-always suspect if no other diagnosis more likely
High RR, HR
Crackles
Pleuritic pain
SOB/SOBOE
Hemoptysis
Leg swelling, erythema
PE
-investigations
PE likely => Immediate CTPA
-DOAC if delayed
CTPA :) => diagnosis confirmed
CTPA :( => leg vein US
PE unlikely => DD within 4hrs
-DOAC if delayed
DD :) => CTPA
DD :( => stop DOAC
Use V/Q scan if renal impairment
DVT Well score
-scoring and interpretation
Wells score
1+ MHx
-active cancer (treatment, within 6 months, palliative)
-recent immobilisation of legs
-recently bedridden for 3days+ or major surgery within 3months needing GA/RA
-past DVT
-collateral superficial veins
1+ presentation
-leg swollen
-calf swelling 3cm greater than asymptomatic side
-pitting edema isolated to affected leg
2- if an alternative diagnosis as likely as DVT
DVT likely - 2
DVT/PE management
PE with haemodynamic instability
Repeat PE’s
1st line - DOAC
Severe renal impairment - LMWH
Provoked - 3months
Unprovoked - 6 months
-but depends on balance between bleeding risk and future clotting risk
Massive PE with low BP
-thrombolysis
Repeats
-IVC filters
PE Wells score
-3
-1.5
-1
3+
-clinical signs of DVT
-alt diagnosis less likely than PE
1.5+
-HR 100+
-immobilisation for 3days+ or surgery in past month
-past DVT/PE
1+
-haemoptysis
-malignancy (treatment, last 6 months, palliative)
4+ - PE likely
