Venous thrombosis Flashcards
where can thrombotic events occur
arteries in coronary, cerebrak or peripheral
venous thrombosis
blood clot which forms ina. vein
atherosclerosis
build up of cholesterol plaque in wall of artery
what does atheroscleoris present with in legs
claudication pain
prevention of arterial thrombosis
aspirin or other antiplatelet drugs
what is a venous thrombosis usually due to
lack of movement
risk factors for venous thrombosis
virchows triad
stasis
vessel wall ; damage to valves
hypercoagulability
what main things damage valves
previous dvt
age
treatment of venous thrombosis
heparin/ warfarin
DVT features
limb feels hot swollen and tender
pitting oedema
PE features
Pulmonary infarction
Pleuritic chest pain
Cardiovascular collapse/death
Hypoxia
Right heart strain
what is right heartvstrain detected on
echo or elctrocardiogram
characterisitc of right heart strain
S1Q1T3
Risk factors for venous thromboembolism
Age
Marked obesity
Pregnancy
Puerperium
Oestrogen therapy
Previous DVT/PE
Trauma/Surgery
Malignancy
Paralysis
Infection
Thrombophilia
what do protein s and c switch off
factor 5 and factor 8
thrombophilia
Familial or acquired disorders of the haemostatic mechanism which are likely to predispose to thrombosis
pathophysiology of venous thrombosis
low pressure system meaning platelets arent activated > coagulation cascade activated due to virchows triad > clot rich in fibrin
dvts of which veins are more likely to embolise
femoral / popliteal
clinical features of a pulmonary embolism
sob
chest pain
dvt symptoms
collapse
fever
haemopytsis
tachycardic
hypoxia
cyanosis
low bp
what test is doen to rule out DVT, if wells score indicates pe unlekly
d dimer if considered unlikely based on wells score
which scan is diagnostic for DVT
us doppler if patient has raised d dimers / high wells score in which case US would be first
what test to perform if wells score indicates pe is liekly
CTPA
what alternative test is used in pregnancy, renal impairment or at risk of radiation
V/Q scan
what ABG pattern willbe shown
type 1 resp failure
initial management for a suspected or confirmed DVT or PE
anticoag; apixaban or rivaroxaban
if not suitable then LMWH followed by dabigatran or edoxaban
first line treatment for massive PE
thrombolysis
secondary prevention in pregnancy
LMWH
second line prevention in antiphos syndrome
warfarin
treatment timeline
○ Provoked DVT with reversible factors - 3 months
Provoked DVT with irreversible factors, or unprovoked DVT - 3-6 months, potentially life-long depending on patient factors (e.g. genetic clotting disorder)
