DVT + VTE Flashcards
What are some risk factors of VTE? (9)
• Immobility
• Recent surgery
• Long haul travel
• Pregnancy
• Hormone therapy with oestrogen
• Malignancy
• Polycythaemia
• Systemic lupus erythematosus
• Thrombophilia
What are thrombophillias? What is the most common one?
Conditions that predispose patients to develop blood clots
Antiphospholipid syndrome
What is antiphospholipid syndrome associated with?
Recurrent miscarriage
What is the common VTE prophylaxis in hospital?
LMWH
What are some contraindications for LMWH prophylaxis? (2)
Active bleeding
Existing anticoagulation with warfarin or DOAC
What is the main contraindication to compression stockings?
Peripheral arterial disease
What are the presenting features of a DVT? (6)
Unilateral
• Calf or leg swelling
• Dilated superficial veins
• Tenderness to the calf (particularly over the site of the deep veins)
• Oedema
• Colour changes to the leg
What measurement is a significant increase in difference for calf circumference?
> 3cm
What is the wells score?
predicts the risk of a patient presenting with symptoms having a DVT or PE
What score predicts the risk of a patient presenting with symptoms having a DVT or PE?
Wells score
What is done if the wells score is likely for DVT?
Perform a leg vein ultrasound
What is done if the wells score is unlikely for DVT?
perform a d-dimer, and if positive, perform a leg vein ultrasound
Aside from VTE what can cause raised d-dimer? (5)
○ Pneumonia
○ Malignancy
○ Heart failure
○ Surgery
○ Pregnancy
Person has a positive d-dimer and likely wells score but leg vein ultrasound is negative. What is done?
Repeat leg vein ultrasound scan after 6-8 days
What is the initial management of DVT?
Treatment dose DOAC
E.g. apixaban or ribaroxaban
When is catheter-directed Thrombolysis indicated in DVT?
patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days.
What is the main long term anticoagulant after VTE?
DOACs
What are some contraindication to DOACs? (3)
severe renal impairment (creatinine clearance less than 15 ml/min)
Antiphospholipid syndrome
Pregnancy
What is the first line long term anticoagulation in those with antiphospholipid syndrome?
Warfarin
What is the first line long term anticoagulant in pregnant?
LMWH
How long is long term anticoagulation continued for a VTE with a reversible cause?
3 months
How long is long term anticoagulation continued for a VTE in active cancer?
3-6 months
How long is long term anticoagulation continued for in an unprovoked, recurrent VTE or irreversible cause?
> 6months
What is an inferior vena cava filter?
designed to filter the blood and catch any blood clots travelling from the venous system towards the heart and lungs. They act as a sieve, allowing blood to flow through whilst stopping larger blood clots
