Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical > DVT and PE > Flashcards

DVT and PE Flashcards

1
Q

What is a DVT?

A

Formation of thrombi within the lumen of the vessels making up the deep venous system - predominantly in venous valve pockets and other sites of presumed stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of DVT?

A

Distal Vein Thrombosis - DVT of the calves

Proximal Vein thrombosis - DVT of popliteal vein or of femoral vein (closer to the heart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a PE?

A

Thromboemboli detach and travel through the right side of the heart to block lung vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Virchow’s triad and causes of 3 reasons?

A 
Endothelial injury:
Venous disorders
Venous valvular disease
Trauma/surgery
In-dwelling catheters
Circulatory stasis: 
Left ventricular dysfunction
Immobility or paralysis
Venous insufficiency or varicose veins
Venous obstruction from tumour, obesity or pregnancy
Hyper-coagulable states:
Malignancy
Pregnancy and peripartum periods
Oestrogen therapy (HRT or contraceptive pill)
Inflammatory Bowel Disease
Sepsis
Thrombophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Significance of Virchow’s triad?

A

All predispose to thrombus formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Exposing risk factors for venous thrombo-embolic disease), i.e: acute conditions or previous happenings?

A 
Surgery
Trauma
Acute medical illness
Acute heart failure
Acute resp failure
Central venous catheterisation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Predisposing risk factors (patient characteristics)?

A 
History of VTE (biggest risk of clot is having had one before)
Chronic heart failure
Advanced age
Varicose veins
Obesity
Immobility or paresis
Myeloproliferative disorders
Pregnancy/peripartum period
Inherited or acquired thrombophilia
Hormone therapies
Renal insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inherited disorders that increase VTE risk?

A

Protein C or Protein S deficiency
Factor V Leiden mutation

Only increase risk by a small amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Difference between provoked and unprovoked VTE?

A

Provoked VTE:
Transient/reversible factors, e.g: surgery or hospitalisation
Continuing/irreversible factors, e.g: cancer

Unprovoked (idiopathic) cause - no identifiable cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Known consequences of VTE?

A 
Fatal PE
Risk of recurrent VTE
Post-thrombotic syndrome (PTS)
Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH)
Reduced quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is post-thrombotic syndrome?

A

Chronic venous disease following DVT treatment
Valves no longer function so there is chronic pooling of blood
Also, valvular reflux leads to venous hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Frequency of PTS?

A

Occurs in nearly 1/3rd of patients within 5 years after idiopathic DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Characteristic of PTS?

A 
Pain
Oedema
Hyperpigmentation - iron deposition leads to staining of skin (hemosiderin deposition)
Eczema
Varicose collateral veins
Venous ulceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is chronic thromboembolic pulmonary hypertension (CTEPH)?

A

Serious PE complication
Original embolic material is replaced with fibrous tissue into the intima and media of pulmonary arteries - pulmonary resistance and right-sided heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Characteristics of CTEPH?

A

Initial phase - often asymptomatic

Followed by progressive dyspnoea and hypoxaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for DVT?

A

Pre-test probability scores:
D-dimer - reasonable test of exclusion (use with caution in patients with previous DVT)

Ultrasound - compressibility vs Doppler ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is D-dimer?

A

Breakdown product of cross-linked fibrin

High -ve predictive value for VTE and low +ve predictive value for VTA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Uses of D-dimer?

A

Valuable first line screening test for suspected VTE with low Wells score

But non-specific (D-dimer is raised in many conditions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Interpreting the Wells score?

A

If low probability, check D-dimer (if -ve, no imaging required)

Moderate/high probability - need imaging regardless of D-dimer (-ve imaging and +ve D-dimer requires repeat imaging)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does Wells score indicate?

A

PE

21
Q

What is Geneva score used for?

A

Low risk - if D-dimer is negative, may not need investigation

Intermediate risk - if D-dimer negative, consider stopping investigation (likely, need investigation to exclude)

High risk - regardless of D-dimer will need imaging

22
Q

Other imaging techniques for PE?

A

CXR - usually normal in PE (can show pleural effusions and occasionally infarct)

V/Q scan - mismatched perfusion defects PE; still useful in small, peripheral PEs and pregnancy but is limited by frequency of inconclusive results

CTPA is “gold standard” (but no good for peripheral pulmonary vessels)

23
Q

Pharmacological and mechanical interventions for DVT and PE?

A

Pharmacological interventions:
Anti-coagulation
Thrombolysis
Analgesia

Mechanical interventions:
Graduation compression stockings
IVC filters

24
Q

Treatment of provoked VTE, to prevent recurrence?

A

Provoked VTA - LMWH for at least 5 days or until INR is greater than or equal to 2, for 24 hours (whichever is longer)

Vitamin-K antagonist (warfarin) within 24 hours and cont. for 3 months

25
Q

Treatment of unprovoked VTE, to prevent recurrence?

A

LMWH for at least 5 days or until INR is greater than or equal to 2, for 24 hours

VKA within 24 hours and cont. for 3 months

Assess risks and benefits of cont. anticoagulation for prevention of VTE recurrence

26
Q

Treatment of VTE in patients with active cancer, to prevent recurrence?

A

LMWH for 6 months

Reassess for continued treatment

27
Q

Advantages of VKA?

A

Mainstay of long-term therapy

Can be used in those with severe renal impairment

Anti-coagulation can be reversed, using vit K

28
Q

Disadvantages of VKA?

A

Slow onset/offset - requires bridging

Numerous INTERACTIONS with other drugs and foods

Narrow TI

Inter-individual variability in dose response

Need for INR monitoring

29
Q

Advantages of Novel Oral Anti-Coagulants (direct)?

A

Predictable pharmacological profiles

Absence of major food and drug interactions

Do not require routine INR monitoring

May shift practice to longer treatment duration

Low bleeding risk and short half-life, so basic first aid could be used

30
Q

Disadvantages of NOACs?

A

No available antidote

No readily available monitoring for special circumstances, e.g: major bleeding, urgent procedure

No long-term data

31
Q

4 NOACs?

A

Apixaban
Rivaroxaban
Dabigatran
Edoxaban

32
Q

Recommendations for Apixaban use?

A

Recommended as an option for treating and preventing DVT and PE in adults

Recommended as an option for prevention of VTE, in adults after elective hip/knee replacement surgery

33
Q

Recommendations for Rivaroxaban use?

A

Option for treating DVT and preventing recurrence and PE, after a diagnosis of DVT in adults

Option for treating PE and preventing recurrence of DVT and PE in adults

Option for prevention of VTE in adults having elective total hip/knee replacement surgery

34
Q

Recommendations for Dabigatran use?

A

Option for primary prevention of VTE inadults who have undergone total hip/knee replacement surgery

Option for treating and preventing DVT recurrence and PE in adults

35
Q

Recommendations for Edoxaban use?

A

Option for treating and preventing recurrent DVT and PE in adults

36
Q

Apixaban, Edoxaban, Rivaroxaban action compared to Dabigatran?

A

3 act on factor Xa

Dabigatran acts as a direct thrombin inhibitor

37
Q

Comparison of VKA and rivaroxaban bleeding rates?

A

Rivaroxaban - significantly lower incidence of major bleeding compared with VKA in fragile patients (aged 75 years and up or those with moderate/severe renal impairment or patients with low body weight)

38
Q

Why is drug use a special case?

A

Risk of haemorrhage/death vs embolic disease

Rivaroxaban vs fragmin use

Are they an active or retired injector? Injecting makes them pro-thrombotic

39
Q

Which drug should be used in cancer?

A

Wight-adjusted FRAGMIN

40
Q

What is phlegmasia?

A

Arterial compromise secondary to extensive DVT - so extensive that there is impaired arterial flow (limb ischaemia)

41
Q

Recommendations for thrombolysis use in DVT?

A

Consider patients with symptomatic ileo-femoral DVT symptoms less than 14 days duration AND:
Goof functional status AND
A life expectancy of 1 year or more AND
A low risk of bleeding

42
Q

Recommendations for thrombolysis use in PE?

A

Consider pharmacological systemic thrombolytic therapy for patients with PE and haemodynamic INSTABILITY (beneficial for those at high risk of deteriorating in hospital)

Do not offer pharmacological systemic thrombolytic therapy for PE and haemodynamic stabilty

43
Q

Why are compression stockings used?

A

To prevent Post-Thrombotic Syndrome after DVT

44
Q

How are compression stockings used?

A

To be worn as soon as possible after diagnosis

To be worn at least 2 years post-thrombosis on affected leg (s)

Must ensure there are no contraindications (individual risk analysis)

45
Q

Major contraindication for compression stocking use?

A

Those with arterial disease

46
Q

Only treatment for PTS?

A

Compression stockings

47
Q

What are IVC filters?

A

Placed in IVC to catch clots

48
Q

When are IVC filters used?

A

NOT ROUTINELY

Main use is temporarily peri-operatively

Temporary use in patients with proximal DVT or PE, who cannot have anti-coagulation treatment

Also, for patients with recurrent DVT or PE despite adequate anti-coagulation, only after considering increasing target INR or LMWH

49
Q

IVC filters complications?

A

Thrombosis - not a replacement for anti-coagulation, ideally

Clinical (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions