Venous Thromboembolism Flashcards
What two conditions are encompassed by venous thromboembolism?
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
What are signs and symptoms of a DVT?
Swelling and pain in the affected extremity
What are signs and symptoms of PE?
Shortness of breath
Pleuritic chest pain
If PE or DVT is suspected, what’s a helpful test we can perform?
D-dimer
VTE can be excluded without imaging if patient has pre-test probabilities of low, moderate or unlikely in combo with negative d-dimer test
If patient is diagnosed with distal DVT (calf veins) and symptoms are not severe, how do we manage?
No treatment needed.
Repeat imaging at 1 week
- No change, no treatment
- Significant clot extension, treat
When should we screen for thrombophilia? What is thrombophilia?
Patient age <40 year with recurrent VTE or family history
Blood that clots more easily
Which VTE patients can be treated outpatient?
Majority of DVT patients
PE patients without compromised cardiopulmonary function
What’s the ideal analgesic for patients with VTE?
Acetaminophen
Opioids may be required for a few days
NSAIDs are effective but increases risk of bleeding, especially if using with anticoagulants
What are non-pharms for DVT?
Rest if needed(reduces pain and swelling)
Evidence suggests early ambulation is preferred (resolves pain and swelling faster)
Elevate swollen limb
What are non-pharms for PE?
Oxygen if hypoxic
IV fluids if hypotensive
Vasopressor if hypotensive or organ hypoperfusion (shock)
What is a frequent complication of DVT?
Post-thrombotic syndrome (PTS)
What are signs and symptoms of PTS?
Chronic swelling and pain
Discomfort when walking
Skin discolouration
Does the compression stockings prevent development of PTS following DVT?
No
What can graduated compression stockings help with in DVT?
Improve edema and pain for DVT.
Relieve symptoms in those who do develop PTS
What patient population should not use graduated compression stockings?
Patients with pre-existing peripheral vascular disease (PAD)
