PE/DVT Flashcards
Presentation, investigation/diagnosis, management, and follow-up.
Most prominent symptom of PE
SOB
Which triad is useful for conceptualising RFs for VTEs?
Virchow’s triad: Haemostasis, hypercoaguable states, endovascular injury.
When is CT-PA performed?
High suspicion of PE, with calculated Well’s score > 4
Indications for V/Q perfusion scan instead of a CT-PA for suspected PE.
**Severe renal impairment (eGFR < 30 mL/min/1.73m²)
**
What would happen if you perform a CT-PA on a patient with GFR<20?
Contrast-induced nephropathy
A 58-year-old woman presents with suspected PE. Her left calf is swollen and tender. Her Wells score is calculated to be 6. However, a CTPA returns a negative result for PE.
What is the most appropriate next step for this patient?
Proximal leg vein ultrasound scan is the most appropriate next step if a CTPA is negative but there is still clinical suspicion of DVT, which could still be the source of emboli despite a negative CTPA.
When is a D-dimer most helpful during the investigation for a PE?
When the Wells score for PE is ≤ 4, it indicates that PE is unlikely. In such cases, a D-dimer test is performed to rule out PE.
Consider alternative diagnosis if low clincal suspicion and D-dimer neg.
Top 2 anticoagulation drug choices for PE/DVT
Apixaban or rivaroxaban.
Length of anticoaulation therapy for a provoked VTE e.g. PE with a clear precipitating factor?
Such as surgery or immobilisation
3 months.
Length of anticoaulation therapy for an unprovoked VTE
6 months.
Threshold for leg scan for suspected DVT
Well’s score 2 or more. 3 or more is highly likely.
