VTE Flashcards
What is VTE?
Venous thromboembolism
- DVT
- PE
How does a thrombus form?
Prothrombin –> thrombin
Thrombin converts fibrinogen –> fibrin
XII converts fibrin –> cross linked fibrin
What are the features of arterial thrombosis?
Rupture of atherosclerotic plaque
Cause ischaemia + infarction
ACS, ischaemic stroke, limb ischaemia
‘White thrombus’- platelets and fibrin
What are the features of venous thrombosis?
Virchow’s triad
DVT and PE
‘Red thrombus’- RBCs and fibrin
What are the symptoms/signs of DVT?
Unilateral limb swelling
Persisting discomfort
Calf tenderness
Warmth
Erythema
Prominent collateral veins
What is the diagnostic algorithm of DVT?
Likely?
- Ultrasound
- D -dimer
- Repeat ultrasound
Unlikely?
- D-dimer
- Ultrasound
What are the features of D-dimer?
High sensitivity but low specificity for venous thromboembolism
What are the symptoms/signs of PE??
Pleuritic chest pain
Dyspnoea
Haemoptysis
Tachycardia
Pleural rub
Collapse
Cyanosis
Low BP
Raised JVP
What investigations are done for PE?
Wells score
D-dimer
Isotope V/Q scan
CT pulmonary angiogram
What is the main treatment of VTE?
Anticoagulation
What are parenteral options of anticoagulation?
LMW heparin
Fractionated heparin
What are enteral options of anticoagulation?
DOACs
Warfarin
