venous thromboembolism

Question 1

What are the 5 presentations of deep vein thrombosis?

c, c, d, l, l, u

Answer 1

• unilateral
• calf/leg swelling and tenderness
• varicose veins
• leg oedema (pain)
• leg colour changes.

Question 2

What are the 6 presentations of pulmonary embolism?

c,h,pcp,sob,t,t

Answer 2

• cough
• haemoptysis
• pleuritic chest pain
• shortness of breath
• tachycardia (>100bpm)
• tachypnoea (shallow breathing)

Question 3

What is provoked venous thromboembolism?

Answer 3

presence of risk factors
e..g. cancer, surgery etc.

Question 4

what is unprovoked venous thromboembolism?

Answer 4

no risk factors

Question 5

what is colour is venous thrombus shown as? what is it made up of?

Answer 5

• red thrombi
• made up of fibrin and red blood cells

Question 6

what is colour is arterial thrombus shown as? what is it made up of?

Answer 6

• white thrombus
• fibrin and platelets

Question 7

describe the pathogenesis of deep vein thrombosis:

Answer 7

• Blood clot formation due to virchows triad in the venous circulation
• secondary to stagnation of blood and hypercoagulable states

Question 8

describe the pathogenesis of pulmonary embolism:

Answer 8

Deep vein thrombosis clot can embolise to heart and enter lung

-> blocking blood flow in pulmonary vasculature

Question 9

Where is deep thrombosis usually presented in?

Answer 9

lower limbs

Question 10

what is virchows triad?

bc, bfp, bvw

Answer 10

changes in:

• blood constituents
• blood flow pattern
• blood vessels walls

Question 11

what are 5 risk factors in changes in the blood constituents?

ca,m,ocp,rs,t

Answer 11

• clotting abnormalities
• malignancy
• oral contraceptive pill
• recent surgery
• trauma

Question 12

what are 3 risk factors in changes in the blood vessel wall?

a,i,pt

Answer 12

• atherosclerosis (plaque buildup of fats etc. in and on artery walls)
• inflammation
• previous thrombosis

Question 13

what are 3 risk factors in changes in the blood flow pattern?

i,hf,p

Answer 13

• immobility e.g. post surgery
• heart failure
• pregnancy

Question 14

what 4 investigations are used for diagnosing pulmonary embolism?

Answer 14

CXR
- look for abnormality e.g. pneumonia

wells score
<4 use D dimer
>4 use CT pulmonary angiogram

D dimer lab test
- PE possible if positive
- PE possibe if negative

ventilation perfusion (VQ) scan
- done in pregnancy to avoid radiation

Question 15

what 2 investigations are used for diagnosing deep vein thrombosis?

Answer 15

wells score
<2 use D dimer
>2 use whole leg doppler ultrasound

D dimer test
- DVT positive if postivie
- DVT negative if negative

Question 16

what investigations are used for diagnosing recurrent venous thromboembolism?

Answer 16

refer to haemotology for blood testing for antiphospholipid antibodies found in antiphospholipid syndrome

Question 17

what is 2 prophylactic (preventative) treatments for suspected venous thromboembolism?

Answer 17

compression stockings for deep vein thrombosis

low moleculat weight heparin (LMWH)

Question 18

What contradictions are there for preventative treatment for suspected VTE? What is the alternative treatment?

Answer 18

active bleeding and existing anticoagulation

use warfarin or…

DOAC
- direct oral acting anticoagulants

Question 19

what treatment is used for confirmed DVT/PE if patient is haemodynamically stable?

Answer 19

DOAC
e.g. apixaban or rivaroxaban for 3 months (provoked) / 6 months (unprovoked)

Question 20

what treatment is used if there are contradictions for a haemodynamically stable patient with confirmed DVT/PE?

Answer 20

LMWH followed by warfarin for 3 months

Question 21

what treatment is used for confirmed DVT/PE if patient is haemodynamically unstable (e.g. hypotensio)/ has a massive PE?

Answer 21

thrombolysis with alteplase

Question 22

what treatment is used if there are contradictions for a haemodynamically unstable patient with confirmed DVT/PE?

Answer 22

thromboectomy

Question 23

What is the first line therapy anticoagulant during pregnancy?

Answer 23

LMWH

Question 24

What is the first line anticoagulant for antiphospholipid syndrome?

Answer 24

warfarin