IC4 Management of VTE Flashcards
What is Deep Vein Thrombosis (DVT)?
DVT is when a thrombus develops in the deep veins.
What is pulmonary embolism (PE)?
A pulmonary embolism (PE) occurs when a part of the DVT clot breaks off and travels to the lungs, which can be life-threatening
What is Venous Thromboembolism (VTE)?
VTE refers to DVT, PE, or both
What are risk factors of VTE?
(List at least 5)
- Immobility
- Recent surgery
- Long haul flight
- Pregnancy
- Hormone therapy w oestrogen
- Malignancy
- Polycythemia
- Obesity
- Antiphospholipid syndrome
- Genetics
- Prothrombin gene mutation
- Antithrombin deficiency
- Protein C & S deficiency - Infection/sepsis
What are the 5 clinical presentations of DVT?
- Unilateral
- Calf swelling
- Dilated superficial veins
- Calf tenderness
- Colour change in legs
What are the 3 main causes of VTE?
(Virchow’s triad)
- Vessel injury
- Venous stasis
- Hypercoagulability
What are the types of test we can do to investigate VTE?
- INR - a clotting test
- Full blood count (FBC)
- Imaging - ultrasound
- APTT - a clotting test
- Liver function test (LFTs)
If a thrombus were to form, at which region will it likely embolise?
Proximal region - Above the knee is more likely to embolise
Distal region - below the knee, less likely to embolise
What is the clinical presentation of Pulmonary Embolism (PE)?
- Cough
- Chest pain
- Chest tightness
- Shortness of breath
- Tarchycardia
- Diaphoretic - increased sweating
- Hypoxia
Wells score is a guideline to determine the likelihood of a patient having DVT:
What score is considered low, moderate and high probability?
Low probability: 0 or less
Moderate probability: 1 or 2
High probability: 3 or more
Active cancer - 1pt
Immobilization of lower extremities - 1pt
Major surgery or bed ridden for >3 days - 1pt
Localized tenderness - 1pt
Entire Leg swollen - 1pt
Calf swelling >3cm -1pt
Pitting oedema - 1pt
Collateral superficial vein - 1pt
Alternative diagnosis more likely than DVT - -2pts
At what Well’s score do we then conduct an ultrasound test?
When the score is greater than 2.
When the score is 3 and above, we must conduct an ultrasound.
At what Well’s score do we conduct D-dimer test?
When score is 0 to 2.
When score is 0-2, we conduct D-dimer test. If D-dimer is positive, we will then perform ultrasound.
If D-dimer is -ve, we are then able to rule out DVT.
After an ultrasound is conducted, it was discovered that the DVT is located at:
- The proximal region
What should you do?
Start anticoagulants immediately
After an ultrasound is conducted, it was discovered that the DVT is located at:
- The distal region
What should you do?
Choose to monitor or initiate anticoagulants
How to diagnose a patient with PE?
A modified Well’s Score is used to check if a patient has PE.
When score is >4, we will conduct an ultrasound.
When score is 4 and below, we will conduct D-dimer test. If D-dimer is positive, we will then conduct an ultrasound.
If patient is found to have PE, we will start on parenteral anticoagulation immediately as it is life threatening.