DVT Management Flashcards
What are some risk factors for DVT?
- Recent travel (immobility)
- Prolonged hospital stay or paralysis
- Pregnancy
- Recent surgery
What past medical history is relevant for DVT risk?
- Malignancy
- Thrombophilia
- Polycythaemia
- Nephrotic syndrome
- Hyperviscosity syndrome
Which medications are associated with an increased risk of DVT?
- COCP
- HRT
- Raloxifene and tamoxifen
- Antipsychotics (especially olanzapine)
What prophylaxis options are available for DVT?
- LMWH
- TED stockings
- Sequential compression devices
What are the focused exam findings for unilateral leg symptoms?
- Leg or calf pain
- Oedema
- Swelling
- Erythema or other colour changes
- Dilated superficial veins
What is phlegmasia cerulea dolens?
- Severe leg pain and oedema
- Cyanosis
- Venous gangrene
- Compartment syndrome + secondary arterial compromise
- Shock and death
uncommon form of massive proximal DVT of lower limb
What are the signs and symptoms of pulmonary embolism (PE)?
Cough, chest pain, shortness of breath, hemoptysis, tachycardia
List the differential diagnoses for DVT.
- Cellulitis (Hot, red, irregular rash and swelling + Fever)
- SUPF thrombophlebitis (Palpable tender superficial veins)
- Popliteal (Baker’s) cyst (Distention of bursa)
- Venous vascular insufficiency (Oedema+Hemosiderin discoloration)
- Lymphoedema
- Calf muscle tear
What investigation is used to assess the likelihood of DVT?
Wells score for DVT
What does a Wells score of >/=2 indicate?
Likely DVT
What is the next step if wells >2 and proximal leg ultrasound is positive for DVT?
Administer anticoagulation
What should be done if wells >2 a proximal leg ultrasound is negative?
- Check D-dimer
- D-dimer positive: stop interim therapeutic anticoagulation and repeat proximal leg vein US in 6-8 days
- D-dimer negative: DVT unlikely
What are the pathological signs in compression ultrasound?
- Abnormal compressibility of veins
- Abnormal Doppler colour flow
- Presence of echogenic band
What are the limitations of compression ultrasound?
- Misses iliac vein and adductor canal clots
- Difficult to see pelvic clots
- Difficult with very obese legs
- Slightly increases risk of clots due to compression
CT venogram is an alternative
What is the appearance of DVT on a CT venogram?
Low-density filling defect in the vein (polo mint sign)
What are the treatment options for DVT?
- DOAC
- LMWH in severe renal impairment or APS
- 3-6 months (malignancy)
- 6 months (un
3 months (reversible ), 3-6 months (malignancy), 6 months (unprovoked)
Antiphospholipd Syndrome (APS) is an autoimmune condition where the body’s immune system mistakenly attacks its own tissues, specifically the phospholipids in blood cells, leading to the formation of antibodies that cause blood clots.
What is the duration of anticoagulation for various causes of DVT?
DOAC (LMWH in severe renal impairment or APS) continued for:
- 3 months (reversible cause)
- 3-6 months (malignancy)
- 6 months (unprovoked)
When should an IVC filter be considered?
For recurrent PEs
Inserted by IR via jugular or femoral route. In place for 6 months
What follow-up is recommended for the first DVT without a clear cause?
- Screen for occult cancer
- Blood tests: FBC, U&Es, Ca2+, LFTs
- Urine dipstick
- CXR
- Gender-specific screening
- Hypercoagulability screen
