VTE Flashcards
What is the rate of recurrence of VTE in the 1) year following, 2) 5 years following first unprovoked episode of VTE?
1) 10%
2) 30%
What defines a massive PE?
Hypotension -systolic BP
With long distance air or road travel what is the increase in risk in the rate of VTE?
2-4 fold increase
What are the 2 situations where thrombophilla testing is considered worthwhile?
- Patients under 50 presenting with recurrent idiopathic VTE
- Symptomatic VTE that has been proven in several family members in more then one generation
What are 2 most common inherited thrombophillias in patients with VTE?
Factor V Leiden
Prothrombin gene mutation
Risk of upper limb thrombosis
Low risk of embolism and PE
How many patients with proximal DVT get PE?
50%
Strong risk factors for VTE (OR >10)
Fracture of lower limb
Hip or knee replacement (highest risk at 2 weeks post op but elevated for 3/12)
Major trauma
Spinal cord injury
Previous VE
Myocardial infarcton (within 3/12)
Hospitalisation of heart failure/AF within 3/12
Moderate risk factors for VTE (OR 2-9)
Arthroscopic knee surgery Chemotherapy Cancer (haematologic/lung/GI/brain/pancreatic) Stroke Post partum Thrombophillia IVF, HRT, OCP Infection IBD
Evaluating people with VTE for malignancy
1 episode - age related screening, basic bloods/CXR
Recurrent or unusual vascular beds - consider more extensive screening (CT, scopes)
What is phlegmasia cerulea dolens?
massive proximal DVT
sudden severe leg pain with swelling, cyanosis, gangrene, compartment syndrome, arterial compromise
Well score for DVT
Active cancer Paralysis or recent cast bedridden for > 3 days Major surgery within 3 months Tender deep veins Entire leg swollen Unilateral calf swelling Pitting oedema Collateral superficial veins
Score 3 or more - high probability
D-dimer sensitivity/specificity
Sensitivity more than 80% for DVT and more than 95% for PE
Poor specificity
Good as rule out test as 95% with normal d-dimer don’t have PE
