DVT & PE Lecture

Question 1

What is DVT

Answer 1

Deep venous thrombosis, thrombus formed in deep venous circulation

Question 2

What is PE

Answer 2

Pulmonary embolism, thrombus embolised and lodges in pulmonary circulation-Travels through right side of the heart to block lung vessels

Question 3

What is VTE

Answer 3

Venous thromboembolic disease covers DVT & PE

Question 4

Types of DVT

Answer 4

Distal vein thrombosis
Proximal vein thrombosis

Question 5

What DVT type cannot be treated fully

Answer 5

distal (of the calves)

Question 6

Why are proximal DVT in popliteal veins or femoral arteries

Answer 6

closer to the heart than the lower calf which would be distal

Question 7

What is Virchow’s triad

Answer 7

3 abnormalities that promote thrombus formation

Question 8

What are the 3 components of Virchow’s triad

Answer 8

• Abnormalities in the blood vessel wall (endothelial injury)
• Abnormalities in blood flow (circulatory stasis)
• Abnormalities in blood clotting components (hypercoagulable state)

Question 9

What risk factors predispose to hypercoagulable state

Answer 9

• Malignancy
• Pregnancy and peripartum period
• Oestrogen therapy
• Inflammatory bowel disease
• Sepsis
• Thrombophilia

Question 10

What risk factors predispose to endothelial injury

Answer 10

• Venous disorders
• Venous valvular damage
• Trauma or surgery
• Indwelling catheters

Question 11

What risk factors predispose to circulatory stasis

Answer 11

• Left ventricular dysfunction
• Immobility or paralysis
• Venous insufficiency or varicose veins
• Venous obstruction from tumour, obesity or pregnancy

Question 12

What are the types of risk factors of VTE

Answer 12

Exposing (medical conditions, acute trauma & surgical intervention)

Predisposing (Patients characteristics e.g. obesity, varicose veins, old age, renal insufficiency)

Cancer & inflammatory diseases are classed in both sections

Question 13

How does VTE present (DVT & PE)

Answer 13

DVT is a painful, swollen, red limb which has heat. Tender along vein

PE is sudden, have shortness of breath, pleuritic pain with collapse or cough up blood= haemoptysis. Hypoxia & tachycardia on OB’s

Question 14

How do you manage a DVT

Answer 14

Oral anticoagulation
(or thrombolysis in highly specialised centres)

Question 15

How do you manage PE

Answer 15

Thrombolysis then oral anticoagulation if HIGH RISK

oral anticoagulation if intermediate/ low risk

Question 16

What is thrombolysis

Answer 16

=Fibrinolysis
- Aggressive clot destruction

Question 17

Which anticoagulants can you use

Answer 17

• Direct oral anticoagulant
• Vitamin K antagonist
• Low molecular weight heparin injections

Question 18

what are direct oral anticoagulants

Answer 18

apixaban or rivaroxaban
have superior safety data used in FIRST LINE therapy

Question 19

what is a vitamin K antagonist

Answer 19

Warfarin
rarely used as DOACs now available

Question 20

What is Post thrombotic syndrome characterised by:

Answer 20

-Pain
-Oedema
-Hyperpigmentation
-Eczema
-Varicose collateral veins
-Venous ulceration

Question 21

What is post thrombotic syndrome (PTS) associated with

Answer 21

DVT-induced damage to valves in the deep veins and valvular reflux leading to venous hypertension

Question 22

What is chronic thromboembolic pulmonary hypertension (CTEPH)

Answer 22

serious complication of PE, initial phase of disease often asymptomatic & followed by progressive:
-Dyspnoea (shortness of breath)
-Hypoxaemia (low O2 in blood)

Question 23

What happens in chronic thromboembolic pulmonary hypertension

Answer 23

original embolic material is replaced over time with fibrous tissue this is
incorporated into the intima and media of the pulmonary arteries.

This material may occlude the pulmonary artery, leading to pulmonary artery resistance and, ultimately, right heartfailure