DVT and PE Flashcards
What is a ‘clot’ made up of?
Fibrin
Platelets
Red blood cells
What forms ‘white’ arterial thrombus?
Platelets
Fibrin
(endothelial damage)
What forms ‘red’ venous thrombus?
Red blood cells
Fibrin
(contact pathway)
What is the typical mechanism for arterial thrombosis?
Rupture of atheromatous plaques
What is the typical mechanism of venous thrombosis?
Virchows triad
Virchow’s Triad is a combination of what?
Stasis
Hypercoagulability
Endothelial damage
What are the biggest causes of blood stasis?
Immobility
Long Haul
What are the biggest causes of acquired hypercoagulability?
Pregnancy
Cancer
Sepsis
PE found in how many autopsies?
20%
Risk factors for VTE
Surgery Obstetrics Lower limb issues Reduced mobility Previous VTE
Symptoms of DVT
Unilateral limb swelling
Discomfort
Calf tenderness
Signs of DVT
Warmth
Erythema
Prominent collateral veins
Unilateral pitting oedema
What is the long term consequence of DVT? At what rate?
Post thrombotic syndrome
20-60% in 2yrs
What is post-thrombotic syndrome?
Damage to venous valves
What are the symptoms of post thrombotic syndrome?
Swelling
Dyscomfort
Pigmentation
Ulceration if severe
How is DVT diagnosed?
Clinical assessment
Wells score
D-dimer
Compression ultrasound
What is D-dimer?
Fibrin breakdown produced produced during fibrinolysis
What, other than DVT, can D-dimer test positive for?
Trauma Malignancy Sepsis Bleeding Surgery
Symptoms of PE
Pleuritic chest pain Breathlessness Haemoptysis Tachycardia Pleural rub
Symptoms of massive PE
Severe dyspnoea Collapse Cyanosis Tachycardia Hypotension Raised JVP
Diagnosis of PE
Clinical assessment Wells/Geneva score Bloods: D-dimer V/Q scan CTPA
When is D-dimer tested in DVT/PE?
Low Wells probability score
When is imaging indicated in DVT/PE?
D-dimer positive
or
High pre-test probability score
Potential long term consequence of PE
Pulmonary arterial hypertension
