venous thromboembolism Flashcards
What are the 5 presentations of deep vein thrombosis?
c, c, d, l, l, u
- unilateral
- calf/leg swelling and tenderness
- varicose veins
- leg oedema (pain)
- leg colour changes.
What are the 6 presentations of pulmonary embolism?
c,h,pcp,sob,t,t
- cough
- haemoptysis
- pleuritic chest pain
- shortness of breath
- tachycardia (>100bpm)
- tachypnoea (shallow breathing)
What is provoked venous thromboembolism?
presence of risk factors
e..g. cancer, surgery etc.
what is unprovoked venous thromboembolism?
no risk factors
what is colour is venous thrombus shown as? what is it made up of?
- red thrombi
- made up of fibrin and red blood cells
what is colour is arterial thrombus shown as? what is it made up of?
- white thrombus
- fibrin and platelets
describe the pathogenesis of deep vein thrombosis:
- Blood clot formation due to virchows triad in the venous circulation
- secondary to stagnation of blood and hypercoagulable states
describe the pathogenesis of pulmonary embolism:
Deep vein thrombosis clot can embolise to heart and enter lung
-> blocking blood flow in pulmonary vasculature
Where is deep thrombosis usually presented in?
lower limbs
what is virchows triad?
bc, bfp, bvw
changes in:
- blood constituents
- blood flow pattern
- blood vessels walls
what are 5 risk factors in changes in the blood constituents?
ca,m,ocp,rs,t
- clotting abnormalities
- malignancy
- oral contraceptive pill
- recent surgery
- trauma
what are 3 risk factors in changes in the blood vessel wall?
a,i,pt
- atherosclerosis (plaque buildup of fats etc. in and on artery walls)
- inflammation
- previous thrombosis
what are 3 risk factors in changes in the blood flow pattern?
i,hf,p
- immobility e.g. post surgery
- heart failure
- pregnancy
what 4 investigations are used for diagnosing pulmonary embolism?
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
what 2 investigations are used for diagnosing deep vein thrombosis?
wells score
<2 use D dimer
>2 use whole leg doppler ultrasound
D dimer test
- DVT positive if postivie
- DVT negative if negative
what investigations are used for diagnosing recurrent venous thromboembolism?
refer to haemotology for blood testing for antiphospholipid antibodies found in antiphospholipid syndrome
what is 2 prophylactic (preventative) treatments for suspected venous thromboembolism?
compression stockings for deep vein thrombosis
low moleculat weight heparin (LMWH)
What contradictions are there for preventative treatment for suspected VTE? What is the alternative treatment?
active bleeding and existing anticoagulation
use warfarin or…
DOAC
- direct oral acting anticoagulants
what treatment is used for confirmed DVT/PE if patient is haemodynamically stable?
DOAC
e.g. apixaban or rivaroxaban for 3 months (provoked) / 6 months (unprovoked)
what treatment is used if there are contradictions for a haemodynamically stable patient with confirmed DVT/PE?
LMWH followed by warfarin for 3 months
what treatment is used for confirmed DVT/PE if patient is haemodynamically unstable (e.g. hypotensio)/ has a massive PE?
thrombolysis with alteplase
what treatment is used if there are contradictions for a haemodynamically unstable patient with confirmed DVT/PE?
thromboectomy
What is the first line therapy anticoagulant during pregnancy?
LMWH
What is the first line anticoagulant for antiphospholipid syndrome?
warfarin
