DVT and PE

Question 1

What is Virchow’s Triad?

Answer 1

Three factors contributing to thrombosis

• stasis
• hypercoagulability
• vessel damage

Question 2

What is the difference between a venous thrombus and an arterial thrombus?

Answer 2

Venous thrombus = red thrombus

• fibrin and red cells
• results in back pressure
• principally due to stasis and hypercoagulability

Arterial thrombus = white clot

• platelets and fibrin
• results in ischaemia and infarction
• principally secondary to atherosclerosis

Question 3

What are some examples of venous thromboembolisms?

Answer 3

Limb DVT
Pulmonary embolism
Visceral venous thrombosis
Intracranial venous thrombosis

Question 4

What are the symptoms and signs of a DVT?

Answer 4

Unilateral limb swelling
Persistent discomfort
Calf tenderness
Warmth
Redness -erythema

May be clinically silent

Question 5

What investigations might be done in suspected DVT?

Answer 5

Wells scoring
D-dimer if low pre-test probability score
Compression ultrasound if d-dimer +ve or high Wells

Question 6

What are some potential long-term consequences of DVT?

Answer 6

Post-thrombotic syndrome

• incidence 20-60% within 2 years of DVT
• swelling
• discomfort
• pigmentation
• ulceration

Question 7

What are the symptoms and signs of a PE?

Answer 7

Pleuritic chest pain
SOB
Haemoptysis
Tachycardia
Pleural run on auscultation

Question 8

What are the symptoms and signs of a massive PE?

Answer 8

Severe, sudden SOB
Collapse
Central cyanosis
Tachycardia
Low BP
Raised JVP
May cause sudden death

Question 9

What investigations are done to diagnose a PE?

Answer 9

Wells or Geneva Score

D-dimer if low score

Isotope V/Q scan
CT pulmonary angiogram
If D-dimer positive or a high Wells/Geneva score

Question 10

What are the potential long term consequences of a PE?

Answer 10

Most recover fully

Pulmonary hypertension

Question 11

What are the aims of treatment in venous thromboembolism?

Answer 11

Prevent clot extension
Prevent clot embolisation
Prevent recurrent clot

Question 12

What are the treatment options in VTE

Answer 12

Anticoagulation is main treatment

• unfractionated heparin/LMWH parenteral
• warfarin/direct oral anticoagulants enteral

Thrombolysis reserved for massive PE

Question 13

How is VTE prevented in hospital?

Answer 13

Early mobilisation
Anti-Embolism Stockings
Other mechanical methods of thromboprophylaxis
Pharmacological thromboprophylaxis