FN: DVT Flashcards
1
Q
epi
A
DVTs occurs in 25% of surgical patients
2
Q
Risk factors: pathophysiology
A
Virchows triad
3
Q
Virchows triad
A
Blood contents
Blood flow
Vessel wall
4
Q
Blood contents
A
- Surgery - raised platelets and raised fibrinogen
- Dehydration
- Malignancy
- Increasing age
5
Q
Blood flow
A
- surgery
- Immobility
- Obesity
6
Q
Vessel wall
A
Damage to veins: esp. pelvic veins
Previous VTE
7
Q
Signs
A
- Peak incidence @ 5-10d post-op
- 65% of belo knee DVTs are asymptomatic
- Calf warmth, tenderness, erythema, swelling
- Mild pyrexia
- Pitting oedema
8
Q
Differential
A
Cellulitits
Ruptured baker cyst
9
Q
Investigations
A
- D-dimers: sensitive but not specific
- Compression US (clot will be incompressible)
- Thromobophilia screen
10
Q
Do a thrombophilia screen if:
A
- no precipitating factors
- Recurrent DVT
- Family Hx
11
Q
Diagnosis
A
- Assess probability using Wells score
- Low-probability - perform D-dimers
- Med/high probaility - compression US
12
Q
Low probability results of D-dimer
A
Negative - excludes DVT
Positive - compression US
13
Q
Rx
A
Anticoagulate
- therapeutic LMWH: enoxaparin 1.5mg/kg/24h SC
- Start warfarin using Tait model: 5mg OD for first 4 d
- Stop LMWH when INR 2.5
14
Q
Duration of anticoagulation
A
below knee: 6-12 wks
Above knee: 3-6 months
On-going cause: indefinitie
15
Q
Graduated compression stockings
A
Consider for prevention of post-phlebitic syndrome
