DVT and PE Flashcards
DVT
= Deep Venous Thrombosis. A thrombus (clot) formed in the deep venous circulation (usually legs) but can be anywhere
PE
Pulmonary Embolism. A thrombus (clot) that has embolised (travelled) and lodged in the pulmonary circulation
VTE
Venous Thromboembolic Disease. Covers both DVT and PE.
What is the definition of a DVT?
Formation of thrombi within the lumen of the vessels that make up the deep venous system
Where do you find a distal DVT?
In the calves
Where would you find a proximal DVT?
in the popliteal vein or the femoral vein
Presentation of DVT?
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
Presentation of PE
Sudden SOB with Pleuritic pain \+/- collapse \+/- Haemoptysis Hypoxia and tachycardia in obs BP may be low
How do you test someone with a result of DVT unlikely (score of 1)
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
Scans used to look for VTEs
Ventilation perfusion scan
ultrasound (gold standard for DVT diagnosis)
CT
What are the characteristics of post thrombotic syndrome?
(occurs in 1/3 patients within 5 years of idiopathic DVT) Pain Oedema Hyperpigmentation Eczema Varicose collateral veins Venous ulceration
What causes varicose veins?
A high pressure in the deep veins causing the superficial veins which feed into them to become dilated
What does a PESI score measure?
The severity of the PE, important in initial management
How is DVT managed?
Oral anticoagulation - small subset in which thrombolysis could be cinsidered in specialist centres
How is a PE managed?
If high risk -Thrombolysis then oral anticoagulation
Intermediate/low risk - oral anticoagulation
What are the anticoagulants used for VTE?
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)
What are the general rules for the duration of treatment of VTE?
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
How do you decide whether to discontinue long term anticoagulation?
HERDOO2 scoring
- men should generally always continue anticoagulation unless they have a bleeding issue
