DVT + PE Flashcards
What is a DVT
Development of a blood clot in one of major deep veins of leg or thigh
What is a PE
Consequence of DVT, embolus travelling to pulmonary vasculature
What is Virchow’s triad?
- Vessel injury
- Venous stasis
- Hypercoagulability/activation of clotting system.
Can lead to DVT
What are risk factors for DVT and PE?
Drugs e.g. COCP, HRT, tamoxifen, olanzapine
Active malignancy Recent major surgery and hospitalisation Recent trauma Medical illness Age Pregnancy Air travel
What are Sx of DVT?
Calf swelling, pain, warmth
Mild fever
Pitting oedema
What are Sx of PE
SOB, pleuritic chest pain, tachycardia/pnoea, may also be DVT Sx. haemoptysis
What Ix in DVT/PE?
Is suspected, calculate a Wells or Geneva score. If -ve, do a D dimer.
(If D dimer results not available in 4 hours, interim anticoagulation)
If its +ve, do a duplex US leg for DVT and CTPA for PE.
Bloods: clotting, platelets, and thrombophilia screen are important
for PE: also do an ECG (sinus tachy), echo instead of CTPA if unstable/after to look at heart, cardiac biomarkers, consider ABG
What is difference between provoked and unprovoked PE?
Provoked - has identifiable cause/risk factors in last 3 months.
Unprovoked doesn’t (look for cancer and thrombophilia)
What are DDx for DVT?
Cellulitis
ruptured Baker’s cyst
achilles tear
haematoma
What are DDx for PE?
ACS pneumothorax pneumonia copd asthma pericarditis
What is Rx of DVT?
(Interim heparin until diagnosis made)
DOAC e.g. apixaban. 3 months or 6 months, provoked or not
IVC filters can be used if medical fails
What are complications of DVT
PE
Bleeding
HIT if heparin used
Post-thrombotic syndrome
What is post-thrombotic syndrome
Chronic obstruction of venous outflow causes venous hypertension, varicose veins, ulceration,
What is Rx of PE
MASSIVE PE - thrombolysis. Haemodynamic instability