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Year 2 > Venous Thrombosis - Diagnosis, Prevention and Treatment of PE/DVT > Flashcards

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

1
Q

Why is DVT diagnosis difficult

A

Symptoms are non-specific

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2
Q

Symptoms of DVT

A

Pain, swelling

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3
Q

Signs of DVT

A

Tenderness
Swelling
Warmth
Discolouration

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4
Q

How does D-dimer levels help in DVT investigation

A

Normal = Exclude diagnosis

Positive = Potential but not confirmation

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5
Q

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

A

Ultrasound compression test on proximal vein or venogram for calf

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6
Q

How is DVT treated

A

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)

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7
Q

Is DVT more spontaneous or provoked after first case

A

Spontaneous

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8
Q

What are the risk factors for DVT

A
  1. Surgery, Immobility, leg fracture
  2. OC pill, HRT, Pregnancy
  3. Long flights and travel
  4. Inherited thrombophilia (familial inheritance)
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9
Q

How can we mechanically prevent DVT

A

Hydration, early mobilisation

Compression stockings

Foot Pumps

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10
Q

Chemical prevention of DVT

A

LMW Heparin

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11
Q

What is the risk of thromboprophylaxis at <40 years

A

Low

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12
Q

How do we treat low risk thromboprophylaxis

A

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

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13
Q

What factors can result in high risk thromboprophylaxis

A

Hip and knee surgery
Pelvis surgery
Malignancy
Prolonged Immobility

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14
Q

How is high risk thromboprophylaxis treated

A

Many surgeries

Daltrparin

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15
Q

What are the main components of a venous thrombi

A

RBC

Fibrin

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16
Q

Where does DVT begin

A

Vein valves

17
Q

What are D-dimers

A

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

18
Q

Mechanism of action of heparin

A
  1. Binds to antithrombin III

2. Antithrombin inactivates thrombin, factor Xa

19
Q

Difference between unfractioned heparin and LMW Heparin

A
  1. Binds to antithrombin

2. Binds to antifactor Xa instead

20
Q

What is the advantage of LMWH and Fondaparinux to Unfratcioned heparin

A

Reduces the risk of heparin-induced thrombocytopenia

21
Q

Why is a common consequence of DVT pulmonary embolism

A

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

22
Q

How can DVT-caused pulmonary embolisms effect the body

A
  1. Hypotension
  2. Cyanosis
  3. Severe dyspnoea
  4. Right heart failure
23
Q

How do we treat DVT with pulmonary embolism

A

Embolectomy or tPA (Thrombolysis)

24
Q

Common presentation of DVT-caused pulmonary embolisms

A
  1. Chest Pain
  2. Sob

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

25
Q

Symptoms of pulmonary embolisms

A
  1. Breathlessness
  2. Pleuritic chest pains
  3. Risk factors
26
Q

Signs of pulmonary embolisms

A
  1. Tachycardia

2. Pleural rub

27
Q

Initial Investigations for PE

A
  1. CXR - Normal

2. ECG sinus tacky (QI, SI, TIII)

28
Q

What should blood gases in initial PE investigation look like

A

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

29
Q

Further investigations after initial check up of PE

A
  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
30
Q

How is PE treated

A

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

31
Q

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

A

IVC filter

32
Q

How is PE prevented

A
  1. Early mobilisation and hydration
  2. Mechanical
  3. LMW Heparin
33
Q

Name two DOACs

A

Rivaroxaban

Apixaban

Year 2 (155 decks)

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