VT/PE

Question 1

What should be undertaken for patients with a suspected deep vein thrombosis (DVT)?

Answer 1

Compression duplex ultrasound should be undertaken where there is clinical suspicion of DVT.

Question 2

What initial investigations should be performed for patients with a suspected pulmonary embolism (PE)?

Answer 2

ECG and chest x-ray should be performed in all patients with suspected PE.

Question 3

What should be done for women with suspected PE who also have symptoms and signs of DVT?

Answer 3

For women with suspected PE who also have symptoms and signs of DVT, compression duplex ultrasound should be performed. If compression ultrasonography confirms the presence of DVT, no further investigation is necessary and treatment for VTE should continue.

Question 4

What factors should influence the decision to perform a V/Q or CTPA for suspected PE?

Answer 4

The decision to perform a V/Q or CTPA for suspected PE should be taken at a local level after discussion with the patient and radiologist.

Question 5

How does CTPA compare to V/Q scanning in terms of lifetime risk of maternal breast cancer?

Answer 5

CTPA slightly increases the lifetime risk of maternal breast cancer (increased by up to 13.6%, background risk of 1/200 for study population).

Question 6

How does pregnancy affect the sensitivity of breast tissue to the effects of radiation?

Answer 6

Pregnancy makes breast tissue particularly sensitive to the effects of radiation.

Question 7

How does V/Q scanning compare to CTPA in terms of risk of childhood cancer?

Answer 7

V/Q scanning carries a slightly increased risk of childhood cancer compared with CTPA (1/50,000 versus less than 1/1,000,000).

Question 8

Why is D-dimer of limited use in the investigation of thromboembolism during pregnancy?

Answer 8

D-dimer is of limited use in the investigation of thromboembolism during pregnancy because it is often raised in pregnancy.