Venous Thrombosis - Diagnosis, Prevention and Treatment of PE/DVT

Question 1

Why is DVT diagnosis difficult

Answer 1

Symptoms are non-specific

Question 2

Symptoms of DVT

Answer 2

Pain, swelling

Question 3

Signs of DVT

Answer 3

Tenderness
Swelling
Warmth
Discolouration

Question 4

How does D-dimer levels help in DVT investigation

Answer 4

Normal = Exclude diagnosis

Positive = Potential but not confirmation

Question 5

Following a D-dimer test what do we carry out for patients with suspected DVT

Answer 5

Ultrasound compression test on proximal vein or venogram for calf

Question 6

How is DVT treated

Answer 6

LMW Heparin for min 5 dyas

Oral Warfarin (5mg a day), INR 2-3 for 6 months

Compression Stockings

Treat underlying cause (malignancy or thrombophilia)

Question 7

Is DVT more spontaneous or provoked after first case

Answer 7

Spontaneous

Question 8

What are the risk factors for DVT

Answer 8

1. Surgery, Immobility, leg fracture
2. OC pill, HRT, Pregnancy
3. Long flights and travel
4. Inherited thrombophilia (familial inheritance)

Question 9

How can we mechanically prevent DVT

Answer 9

Hydration, early mobilisation

Compression stockings

Foot Pumps

Question 10

Chemical prevention of DVT

Answer 10

LMW Heparin

Question 11

What is the risk of thromboprophylaxis at <40 years

Answer 11

Low

Question 12

How do we treat low risk thromboprophylaxis

Answer 12

Early mobilisation, hydration (no chemical intervention) and a 30 min surgery

Question 13

What factors can result in high risk thromboprophylaxis

Answer 13

Hip and knee surgery
Pelvis surgery
Malignancy
Prolonged Immobility

Question 14

How is high risk thromboprophylaxis treated

Answer 14

Many surgeries

Daltrparin

Question 15

What are the main components of a venous thrombi

Answer 15

RBC

Fibrin

Question 16

Where does DVT begin

Answer 16

Vein valves

Question 17

What are D-dimers

Answer 17

Fibrin degradation product that can increase when plasmin is dissolving a clot

Question 18

Mechanism of action of heparin

Answer 18

1. Binds to antithrombin III

2. Antithrombin inactivates thrombin, factor Xa

Question 19

Difference between unfractioned heparin and LMW Heparin

Answer 19

1. Binds to antithrombin

2. Binds to antifactor Xa instead

Question 20

What is the advantage of LMWH and Fondaparinux to Unfratcioned heparin

Answer 20

Reduces the risk of heparin-induced thrombocytopenia

Question 21

Why is a common consequence of DVT pulmonary embolism

Answer 21

The clot can detach and move into the heart, pushed into the lungs where it can lodge

Question 22

How can DVT-caused pulmonary embolisms effect the body

Answer 22

1. Hypotension
2. Cyanosis
3. Severe dyspnoea
4. Right heart failure

Question 23

How do we treat DVT with pulmonary embolism

Answer 23

Embolectomy or tPA (Thrombolysis)

Question 24

Common presentation of DVT-caused pulmonary embolisms

Answer 24

1. Chest Pain
2. Sob

Could be mistaken for malignancy, infection, cardiac or gastric causes - NOTE

Question 25

Symptoms of pulmonary embolisms

Answer 25

1. Breathlessness 2. Pleuritic chest pains 3. Risk factors

Question 26

Signs of pulmonary embolisms

Answer 26

1. Tachycardia | 2. Pleural rub

Question 27

Initial Investigations for PE

Answer 27

1. CXR - Normal | 2. ECG sinus tacky (QI, SI, TIII)

Question 28

What should blood gases in initial PE investigation look like

Answer 28

1, Type I rest failure and decreased O2 and Co2 levels

Question 29

Further investigations after initial check up of PE

Answer 29

1. D-dimer (should be normal = exclude diagnosis) 2. Ventilation/Perfusion sac (mismatch defects) 3. CTPA spiral CT with contrast to visualise major segmental thrombi

Question 30

How is PE treated

Answer 30

NOTE: ENSURE NORMAL Hb, platelets, renal function and baseline clotting LMW heparin of weight adjusted 5/7 Oral Warfarin INR 2-3 for 6 months DOAC Treat cause

Question 31

IF a person with PE can't anti-coagulate what do we give them

Answer 31

IVC filter

Question 32

How is PE prevented

Answer 32

1. Early mobilisation and hydration 2. Mechanical 3. LMW Heparin

Question 33

Name two DOACs

Answer 33

Rivaroxaban | Apixaban