DVT and PE Flashcards

1
Q

DVT

A

= Deep Venous Thrombosis. A thrombus (clot) formed in the deep venous circulation (usually legs) but can be anywhere

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2
Q

PE

A

Pulmonary Embolism. A thrombus (clot) that has embolised (travelled) and lodged in the pulmonary circulation

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3
Q

VTE

A

Venous Thromboembolic Disease. Covers both DVT and PE.

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4
Q

What is the definition of a DVT?

A

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

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5
Q

Where do you find a distal DVT?

A

In the calves

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6
Q

Where would you find a proximal DVT?

A

in the popliteal vein or the femoral vein

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7
Q

Presentation of DVT?

A

Classical presentation
Painful, swollen limb with redness and heat
Vein is tender
Sub acute development
no other obvious cause
Complaints of a shiny leg are quite common in patients

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8
Q

Presentation of PE

A
Sudden SOB with Pleuritic pain
\+/- collapse
\+/- Haemoptysis
Hypoxia  and tachycardia in obs
BP may be low
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9
Q

How do you test someone with a result of DVT unlikely (score of 1)

A

Do a d-dimer test if it is negative the patient doesn’t need further investigation into the problem. If it is positive then a scan is needed to see whether the patient has a DVT

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10
Q

Scans used to look for VTEs

A

Ventilation perfusion scan
ultrasound (gold standard for DVT diagnosis)
CT

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11
Q

What are the characteristics of post thrombotic syndrome?

A
(occurs in 1/3 patients within 5 years of idiopathic DVT)
Pain
Oedema
Hyperpigmentation
Eczema
Varicose collateral veins 
Venous ulceration
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12
Q

What causes varicose veins?

A

A high pressure in the deep veins causing the superficial veins which feed into them to become dilated

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13
Q

What does a PESI score measure?

A

The severity of the PE, important in initial management

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14
Q

How is DVT managed?

A

Oral anticoagulation - small subset in which thrombolysis could be cinsidered in specialist centres

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15
Q

How is a PE managed?

A

If high risk -Thrombolysis then oral anticoagulation

Intermediate/low risk - oral anticoagulation

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16
Q

What are the anticoagulants used for VTE?

A

Direct Oral anticoagulant, 1st line - apixaban or rivoxaban
Vitamin K antagonist - warfarin (rarely used direct instead)
Low molecular weight heparin injections (patients with active cancer and PE)

17
Q

What are the general rules for the duration of treatment of VTE?

A

Provoked VTE with reversible factor = 3-6 months
Provoked VTE with irreversible factor= 3-6 month or lifelong depending on patient (particularly their risk of bleeding)
Unprovoked VTE = normally lifelong

18
Q

How do you decide whether to discontinue long term anticoagulation?

A

HERDOO2 scoring

- men should generally always continue anticoagulation unless they have a bleeding issue