VTE

Question 1

VTE risk factors

Answer 1

oestrogen hormone therapy - COCP, HRT
polycythaemia
fam history
SLE
thrombophilias
immobility, long haul flights, surgery, recent preganncy

(smoking is not a strong risk factor)

Question 2

VTE prophylaxis

Answer 2

LMWH - enoxaparin
- if contraindicated - warfarin or DOAC (active bleeding or existing coagulation)

antiembolic compression stockings - contraindicated in peripheral arterial disease

Question 3

Wells score

Answer 3

predicts risk of patient presenting with symptoms having DVT or PE
- risk facors + clinical findings

Question 4

diagnosising VTE

Answer 4

doppler US
- repeat negative scans after 6-8days if positive DDimer + likely Wells score

PE - CTPA or VQ scan if kidney impairment/contrast allergy

D-dimer useful for excluding where there is low suspicion - raised in DVT
(other conditions that raise it - pneumonia, malignancy, HF, surgery, pregnancy)

Question 5

management

Answer 5

initial
- apixaban or rivaroxabn - start immediately where DVT/PE suspected + delay in scan
- consider catheter directed thrombolysis

long term
- DOAcs
- warfarin - first line in antiphospholipid syndrome

• LMWH -> 1st line in pregnancy

Question 6

how long should anticoag be continued for post VTE

Answer 6

3 months if reversible cause then review

> 3months if unclear, recurrent or irreversible (thrombophilia)

3-6months in active cancer

Question 7

pregnancy + VTE/PE

Answer 7

pregnancy is hypercoaguable state
- majority occur in last trimester

incease in factors VII, VIII, X + fibrinogen
decrease in protein S
uterus presses on IVC causing venous stasis in leg

mx = LMWH

Question 8

APTT, PT + bleeding time in haemophilia

Answer 8

APTT - increased
PT - normal
bleeding time - normal

Question 9

APTT, PT + bleeding time in von Willebrand’s disease

Answer 9

APTT - increased
PT - normal
bleeding time - increased

Question 10

APTT, PT + bleeding time in vit K deficiency

Answer 10

APTT - increased
PT - increased
bleeding time - normal