Venous Thromboembolism

Question 1

what are the components of Virchow’s triad

Answer 1

1. venous stasis
2. hypercoagulation
3. vascular injury

Question 2

risk factors for VTE

Answer 2

Immobility
Recent surgery 
Long haul flights 
HRT, OCP
Pregnancy 
Malignancy
Polycythemia

Question 3

presentation of a deep vein thrombosis (DVT)

Answer 3

unilateral hot, swollen, tender limb

Question 4

what score should be calculated for patients with suspected DVT

Answer 4

A Wells score

Question 5

investigation of a suspected DVT

Answer 5

Duplex USS within 4 hours if Wells score >2
D-Dimer
- if USS -ve
- if Wells score <2

Question 6

how accurate is a d-dimer?

Answer 6

it is sensitive but not specific

• if negative it excludes thrombosis
• will be raised in DVT, but also can be raised in pneumonia, malignancy, RA

Question 7

If D-Dimer is +ve and USS -ve, what should the management of the patient be

Answer 7

repeat USS in 6-8 days

Question 8

if USS cannot be carried out within 4 hours, how should patient be managed?

Answer 8

arrange D-Dimer

give apixaban / rivaroxaban

Question 9

1st line therapy once DVT confirmed

Answer 9

apixaban / rivaroxaban

Question 10

how long should tx continue for a patient with a provoked DVT e.g following surgery

Answer 10

3 months

Question 11

how long should tx continue for a patient with an unprovoked DVT

Answer 11

6 months

Question 12

what is post thrombotic syndrome

Answer 12

complication following DVT

- venous outflow obstruction + venous insufficiency result in chronic venous HTN

Question 13

symptoms of post thrombotic syndrome

Answer 13

painful heavy calves
pruritis
swelling 
varicose veins
venous ulcers

Question 14

what drug is given to woman at risk of VTE in pregnancy

Answer 14

LMWH