DVT and PE

Question 1

What is a distal DVT?

Answer 1

A DVT of the calves

Question 2

What is a proximal DVT?

Answer 2

A DVT of the popliteal vein or femoral vein

Question 3

What is the definition of a DVT?

Answer 3

The formation of thrombi within the lumen of the vessels that make up the deep venous system

Question 4

What can cause hypercoaguable states?

Answer 4

Malignancy 
Pregnancy and peripartum period 
Oestrogen therapy - contraceptive pill 
Inflammatory bowel disease 
Sepsis 
Thrombophilia

Question 5

What can cause circulatory stasis?

Answer 5

Left ventricular dysfunction
Immobility or paralysis
Venous insufficiency or varicose veins
Venous obstruction from tumour, obesity or pregnancy

Question 6

What can ccause endothelial injury?

Answer 6

Venous disorders
Venous valvular damage
Trauma or surgery
Indwelling catheters

Question 7

What are examples of thrombophilias?

Answer 7

Protein C deficiency
Protein S deficiency
Factor 5 Leiden mutation

Question 8

What are examples of provoked VTE?

Answer 8

Transient/reversible factors (surgery or hospitalization)

Continuing/irreversible factors (cancer)

Question 9

What are examples of unprovoked VTE?

Answer 9

No identifiable cause - idiopathic

Question 10

What are known complications of venous blood clots?

Answer 10

Fatal PE
Risk of recurrent DVT
Post-thrombotic syndrome
Chronic thromoboembolic pulmonary hypertension (CTEPH)
Reduced quality of life

Question 11

What is post thrombotic syndrome?

Answer 11

Pain, oedema, hyperpigmentation, excema, varicose collateral veins, venous ulceration. DVT-induce damage to valves in the deep veins and valvular reflux leading to venous hypertension

Question 12

What is CTEPH?

Answer 12

Original embolic material is replaced over time with fibrous tissue that is incorporated into the intima and media of pulmonary arteries. This can occlude pulmonary arteries leading to resistance and ultimately right heart failure.

Question 13

What is the clinical presentation of CTEPH?

Answer 13

Asymptomatic at first

Progressive dyspnoea and hypoxeamia

Question 14

How is a DVT investigated?

Answer 14

D-dimer as a test of exclusion

Ultrasound - compression or a doppler

Question 15

What does a d-dimer show?

Answer 15

The level of cross-linked fibrin in the blood - it is released when a clot forms

Question 16

What score is used in determining severity of DVT?

Answer 16

Wells score - low = check d-dimer

Mod/high = need imagine

Question 17

What imagine techniques can be used to detect a DVT/PE?

Answer 17

Ultrasound, doppler, CT pulmonary angiogram, CXR, V/Q scan

Question 18

How is a DVT/PE treated?

Answer 18

Pharmacological = anti-coagulation, thrombolysis, analgesia
Mechanical = compression stockings, IVC filters
Screening = cancer, thrombophilia
Patient info

Question 19

What is a VKA?

Answer 19

Vitamin K antagonist (warfarin)

Question 20

What is a NOAC?

Answer 20

Non-vitamin K antagonist oral anticoagulants.
Dabigatran (direct thrombin inhibitors)
Rivaroxiban (factor 10a direct inhibitor)

Question 21

What is a complication of an IVC filter?

Answer 21

A fistula between the IVC and aorta due to thin walls.
Afistulais an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs.