VTE Flashcards
What are the 3 components of Virchow’s triad? Does it predispose arterial or venous clots?
Endothelial dysfunction
Venous stasis / turbulent flow
Hypercoagulability
Venous
A PE occurs when a thrombus embolizes and travels through the _____ side of the heart and becomes lodged in the _____, may cause right heart strain
A PE occurs when a thrombus embolizes and travels through the RIGHT side of the heart and becomes lodged in the PULMONARY ARTERIES, may cause right heart strain
Compression stockings are used for patients that have a high VTE risk. What is the contraindication to their use?
Significant peripheral artery disease
What drug is used prophylactically for patients at high VTE risk?
LMWH dalteparin
What is the Well’s score?
Predicts the risk of a patient with symptoms actually having a DVT:?
A DVT causes unilateral swelling and tenderness, dilated superficial veins, redness and oedema. What examination test can be done for a suspected DVT?
Measure calf distance 10cm down from tibial tuberosity, >3cm is significant
What test is used for diagnosis of a DVT? What investigation is done alongside to aid diagnosis?
Doppler US for diagnosis
Measure D-dimers
What is the sensitivity and specificity of d-dimers in DVT?
100% sensitivity
Low specificity
AKA everyone with a DVT will have high d-dimers but not everyone with high d-dimers will have a DVT
(also raised by pneumonia, malignancy, surgery, HF, pregnancy)
What is the acute management of a DVT?
LMWH dalteparin BEFORE confirming diagnosis
What is the long term management of a DVT? How long is treatment continued for?
Anticoagulation (warfarin or DOAC or LMWH)
For 3mth if obvious reversible cause
For 6mth if cause unclear or active cancer
What is the 1st line management of a DVT in pregnancy?
LMWH dalteparin
If a VTE is unprovoked and there is a FH of VTE, NICE recommends checking for what ?
Hereditary thrombophilia - commonest is factor V Leiden deficiency
What surgical procedure can be done for patients with recurrent DVTs?
IVC filter
If a patient presents with an unprovoked VTE, NICE predicts checking for APS antibody. It also recommends checking for cancer, what tests should be done?
Through history/exam FBC, U+Es, LFTs, Urinalysis CXR CT abdo pelvis if >40ry Mammogram in women >40yr
What is Budd-Chiari syndrome? What is the triad?
Hepatic vein thrombosis
Abdo pain + hepatomegaly + ascites
(Also causes acute hepatitis)
Describe the chest pain in a PE
Pleuritic chest pain worse on inspiration
Can a PE cause a low grade fever? Or a raised JVP? Or haemoptysis?
PE can cause a low grade fever, a cough with or without blood and a raised JVP
Well’s score predicts the likeliness of a patient with PE symptoms actually having a PE. If the score is ABOVE what… what investigation should be done?
If Well’s score above 4 do CTPA
Well’s score predicts the likeliness of a patient with PE symptoms actually having a PE. If the score is BELOW what… what investigation should be done?
If Well’s score below 4 do d-dimers
If normal rule out PE, if high do CTPA
When investigating a PE, if a patient can’t tolerate contrast from a CTPA, what investigation can you do as an alternative?
V/Q scan
What is the ECG appearance in a PE?
- Most normal or sinus tachycardia
- ST depression
- AF (new or revert)
- Right heart strain: ST depression in anterior leads, new RBBB)
- S1Q3T3 (deeper S waves in lead I, Q waves in lead III, inverted t waves in lead III)
What is the initial management of a PE?
DOAC (apixaban, rivaroxaban), BEFORE confirming diagnosis
Plus oxygen, analgesia
Name 3 DOACS
Apixaban, rivaroxaban, dabigatran
How long should anticoagulation be continued in a PE?
3 month if obvious reversible cause
6 month if unclear cause / active cancer
1st line long term management of a PE in pregnancy or cancer?
LMWH (not a DOAC)
What are the indications for thrombolysis in a PE? What fibrinolytic drug is used?
If a massive PE with haemodynamic compromise
Streptokinase
What is the commonest blood gas pattern seen in a PE and why?
Respiratory alkalosis
(Due to high RR blowing off CO2 causing low blood CO2 so alkalosis)
(Other main cause of respiratory alkalosis is hyperventilation; would have a normal pO2 but low pO2 in PE)
