General: DVT Flashcards
Outline the pathophysiology of DVT
Clot in the deep veins of the leg
Abnormal blood flow = usually due to recent immobility, such as a long-distance flight or being bed-bound in hospital
Abnormal blood components = can be caused by multiple factors, such as smoking, sepsis, malignancy, or even inherited blood disorders (e.g. Factor V Leiden)
Abnormal vessel wall = can be from atheroma formation, inflammatory response, or direct trauma
What are the risk factors of DVT?
Increasing age
Previous VTE
Smoking
Pregnancy
Recent surgery = especially abdo, pelvic, hip, knee
Prolonged immobility = >3 days
HRT
Oral contraceptive pill
Active malignancy
Obesity
Thrombophilia disorder
What are the signs and symptoms of DVT?
Asymptomatic = 66%
Unilateral leg pain
Swelling
Erythema
Low grade pyrexia
Pitting oedema
Tenderness
Prominent superficial veins
How would you investigate DVT?
Wells Score
- Score < 1 = DVT is clinically unlikely, requires a further D-dimer test to exclude
- Score > 1 = DVT is clinically likely and a DVT diagnosis should be confirmed via either a ultrasound scan (more common) or a contrast venography (rarely used)
How would you manage DVT?
Direct oral anticoagulants (DOACs) = apixaban, rivaroxaban
Vit K antagonist = warfarin (LMWH to cover until INR sufficiently therapeutic
LMWH = recommended in pts with cancer-associated VTE
What are the complications of DVT?
PE
What are the characteristics of D-Dimers?
Sensitive but not specific, may also be raised following recent surgery or trauma, with ongoing infection or inflammation, concurrent liver disease, or pregnancy.
What preventative measures are you aware of to try to prevent DVT?
Compression stockings
Intermittent pneumatic compression
Low molecular weight heparin (LMWH), unless poor renal function (eGFR<30) then consider unfractionated heparin (UFH)
