DVT and PE Flashcards
Presentation of DVT?
Painful Swollen limb Redness Heat Tenderness along vein Sub-acute development No other obvious cause
Presentation of PE?
Sudden SOB with pleuritic pain
+- collapse +- heamoptysis +-Hypoxia and tachycardia
BP may be low
Scoring system for PE probability?
WELLS Score
What is D-Dimer?
Breakdown product of cross-linked fibrin
If a D Dimer has a high negative result?
->98% for VTE
No further investigations needed?
If there is a moderate to high probability a patient has a VTE what do they need?
Scan
Scan done for PE?
CT pulmonary angiogram (CTPA)
Severity assessment for
- DVT
- PE?
- Almost always symptomatic, clinical assessment, not very serious
- PESI score (PE severity index score) because for PEs there can be a risk of deterioration and death as PEs put strain on right heart
What is PTS?
Post thrombatic syndrome
Characteristics of PTS?
Pain Oedema Hyperpigmentation Eczema Varicose collateral veins Venous ulceration
When does PTS occur?
Approx 5 years after treatment for VTE, in 1/3 of patients
What is thought to be associated with PTS?
DVT-induced damage to valves in the deep veins and valvular reflux leading to venous hypertension are thought to be associated with PTS.4
Management of DVT?
Oral anticoagulation
highly specialised centres could consider thrombolysis
PE management?
High risk Thrombolysis then anticoagulation Intermediate risk= Oral anticoagulation
What is thrombolysis othere name?
Fibrinolysis
What does thrombolysis do?
Aggressive clot destruction
Examples of direct anti-coagulant?
Apixaban
Rivaroxaban
1st line therapy
Only time warfarin hsould be used?
Metal valve
Anti-phospholipid syndrome
Vitamin K antagonist example?
Warfarin
- rarely used now
Low molecular wight heparin Injections?
Used in patients with active cancer and PE
Examples of anti-coagulants to treat with?
Direct oral anticoagulant
Vitamin K antagonist
Low molecular weight heparin injection
How long to treat provoked VTE with reversible factor for?
3-6 months
Duration to treat provoked VTE with irreversible factors?
3-6 months
or
Lifelong depending on patient factors
Duration to treat unprovoked VTE with
- Transient risk factor
- Non-major transient risk factor
- Woman with unprovoked VTE
- Man with unprovoked VTE?
- 3 months
- 3 months or long term
- Long term
- Long term
Advice for man with unprovoked VTE?
Recommend life long anti coagulants ubless bleeding issue
Scoring system to see whether to keep patients on anti-coagulants?
HERDOO-2
Define DVT?
Deep Vein Thrombosis
Clot (thrombus)formed in the deep venous circulation (usually legs) but can be anywhere
Define PE?
Pulmonary Embolism
Thrombus (clot) that has embolised (travelled) and lodged in the pulmonary circulation
Define PTE?
Venous Thromboembolic Disease
Covers both DVT and PE
Where DVTs form?
Thrombi form predominately in venous valve pockets and other sites of presumed stasis
Where PEs form?
Thromboemboli detach and travel through the right side of the heart to block vessels in the lungs
What does distal vein thrombosis refer to?
DVT of the calves
Proximal vein thrombosis?
DVT of the popliteal vein or femoral vein- closer to the heart
Definition of DVT in depth?
Formation of thrombi within the lumen of the vessels that make up the deep venous system
3 abnormalities that promote thrombus formation?
Hypercoagulable state (Abnormalities in blood clotting components) Circulatory stasis (Abnormalities in blood flow) Endothelial Injury (abnormalities in blood vessel wall)
Examples of conditions which have abnormalities in blood clotting components?
Malignancy Pregnancy and peripartum period (short period before, during and after giving birth) Oestrogen therapy Inflammatory bowel disease Sepsis Thrombophillia
Diseases associated with abnormalities in blood vessel wall?
Venous disorders
Venous valvular disease
Trauma or surgery
Indwelling catheters
Conditions associated with abnormalities in blood flow?
Left ventricular dysfunction
Immobility or paralysis
Venous insufficiency or varicose veins
Venous obstruction from tumour, obesity or pregnancy
Risk factors for VTE general?
Cancer
Inflammatory diseases
Exposing risk factors for VTE?
Surgery Trauma Acute medical illness Acute heart failure Acute respiratory failure Central venous catheterisation
Predisposing risk factors for VTE?
History of VTE Chronic heart failure Advanced Age Varicose veins Obesity Immobility or paresis Myeloproliferative disorder Pregnancy/ peripartum period Inherited or acquired thrombophilia Hormone therapies Renal insufficiency
