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Year 4 - Cancer Care > Haem - DVT and VTE > Flashcards

Haem - DVT and VTE Flashcards

1
Q

What is a VTE?

A

Thrombus develops in circulation, it embolises from deep vein

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2
Q

When can a VTE cause a stroke?

A

If the patient has a septal defect, the thrombus can pass to the left side of the heart and travel to the systemic circulation and go to the brain

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3
Q

What are the risk factors for developing a VTE?

A

Immobility
Recent surgery
Long haul travel
Pregnancy
Hormone therapy (with oestrogen)
Malignancy
Polycythaemia
SLE
Thrombophilia

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4
Q

What should you ask if a patient presents with features of a DVT or PE?

A

Risk factors e.g. immobility, surgery and long-haul flights

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5
Q

What are some examples of thrombophilias?

A

Antiphospholipid syndrome
Factor V Leiden
Antithrombin defieciency
Protein C or S deficiency
Hyperhomocysteinaemia
Prothrombin gene variant
Activated protein C resistance

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6
Q

When should you suspect antiphospholipid syndrome?

A

Recurrent miscarriage

Diagnose with blood test for antiphospholipid antibodies

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7
Q

What VTE prophylaxis is used in hospital?

A

Given to patients with increased risk

  • Low molecular weight heparin e.g. dalteparin
    Contraindicated in active bleeding or existing warfarin or DOAC use
  • Anti-embolic compression stockings
    Contraindicated in peripheral arterial disease
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8
Q

How do DVTs present?

A

Unilateral
- Calf or leg swelling
- Dilated superficial veins
- Calf tenderness
- Oedema
- Colour changes in leg

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9
Q

What does a bilateral DVT suggest?

A

Rare

More likely due to chronic venous insufficiency or heart failure

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10
Q

How is the calf circumference measured?

A

10cm below tibial tuberosity

More than 3cm difference is significant

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11
Q

What is used to predict risk of a patient having a DVT or PE?

A

Wells Score

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12
Q

How is a DVT diagnosed?

A

Wells score is used to guide next steps

Likely - perform a leg vein utlrasound
Unlikely - perform d-dimer, if positive leg vein ultrasound

USS of the leg is required to diagnose DVT

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13
Q

Why is a D-dimer sensitive but not specific?

A

If there is a raised D-dimer it will be detected with high precision

May be multiple reasons for a raised d-dimer
- Pneumonia
- Malignancy
- Heart failure
- Surgery
- Pregnancy

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14
Q

If there is a negative USS and the patient has a positive D-dimer and likely Wells score when should an USS be repeated?

A

6-8 days later

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15
Q

What is the first-line imaging for pulmonary embolisms?

A

CT pulmonary angiogram (CTPA)

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16
Q

What is the initial management for a DVT?

A

Apixaban or rivaroxaban

LMWH is the main alternative

Start immediately in patients with suspected DVT or PE

Catheter-directed thrombolysis in symptomatic iliofemoral DVTs and symptoms lasting less than 14 days

17
Q

What options are available for long-term anticoagulation in VTE?

A

DOAC e.g. apixaban, rivaroxaban, edoxaban and dabigatran
Warfarin
LMWH

18
Q

When can a DOAC not be used?

A

Severe renal impairment
eGFR under 15

Antiphospholipid syndrome

Pregnancy

19
Q

What is the target INR in warfarin use?

A

2-3

First line for patients with antiphospholipid syndrome

20
Q

When is LMWH first-line?

A

Anticoagulant in pregnancy

21
Q

How long is anticoagulation continued for?

A

3 months
Reversible cause, then review

3-6 months
Active cancer, then review

Long-term
Unprovoked VTE
Recurrent VTE or irreversible underlying cause e.g. thrombophilia

22
Q

What is an IVC filter?

A

Filter inserted into IVC to filter any blood clots from venous system going towards heart and lungs

23
Q

When is an IVC filter used?

A

Patients not suitable for anticoagulation or where a PE has occurred while on anticoagulation

24
Q

What do you do when patients have a VTE with no clear cause?

A

Review medical history
Baseline bloods
Physical exam for any cancers

Patients will have anticoagulation for more than 6 months as it was unprovoked, therefore test for :
- Antiphospholipid syndrome
- Hereditary thrombophilias (only if first-degree relative affected by DVT or PE)

25
Q

What is Budd-Chiari syndrome?

A

Obstruction to outflow of blood from liver caused by thrombosis in hepatic veins or IVC

26
Q

What is Budd-Chiari syndrome associated with?

A

Hypercoagulable states e.g. myeloproliferative disorders

27
Q

How does Budd-Chiari syndrome present?

A

Abdominal pain
Hepatomegaly
Ascites

28
Q

How is Budd-Chiari syndrome diagnosed?

A

Doppler USS

29
Q

How is Budd-Chiari syndrome treated?

A
  • Anticoagulation e.g. LMWH and warfarin
  • Endovascular procedures
  • Transjuglar intrahepatic portosystemic shunt (TIPS)
  • Liver transplant

Year 4 - Cancer Care (17 decks)

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