VTE Flashcards
Why is pregnancy prothrombotic?
Venous stasis in lower limbs
Possible trauma to pelvic veins during labour
Changes in coagulation system:
- Increased procoagulation factors (X, VII and fibrinogen)
- Decreased anticoagulation activity
- Suppression of fibrinolysis
- Decreased protein S activity
Signs/symptoms of DVT?
Leg pain + swelling Erythema, increased skin temp, oedema Tenderness Lower abdo pain (in high DVT) Elevated WBCs
Signs/symptoms of PE?
Pleuritic chest pain Dyspnoea Collapse Tachycardia Hypotension Increased JVP Absent breath sounds DVT signs - 90% in left leg, 70% above knee
WELLS score
1 point:
- Active cancer
- paralysis/immobilisation of lower limb
- Bedridden for >3 days / GA surgery in last 12 weeks
- Localised tenderness
- Whole leg swollen
- Calf swelled >3cm than asymptomatic
- Pitting oedema
- Collateral superficial veins (non-varicose)
- Previously documented DVT
- 2 points
- Alternative diagnosis more likely
WELLS score guided treatment?
<2 = D-dimer >2 = Proximal leg ultrasound
Investigations for suspected PE?
ECG
CXR
ABG
CTPA
Ventilation/perfusion scanning
Bilateral doppler leg examination
Treatment
LMWH S/C:
- Enoxaparin 1mg/kg OD
- Dalteparin 100units/kg BD
Stop just before labour and start 24hrs post delivery - use compression stockings
Post-natal treatment
Therapeutic anticoagulation (warfarin) for 6 months
Treatment (LMWH) should be continued foe at least 1 week (up to 6 weeks)
Prevention
Risk assessed at booking, before C-section, hospitalisation and before labour
Hx of previous VTE - screen for inherited and acquired thrombophilia
mobilisation and hydration
Compression stocklings - when LMWH is CI (i.e. labour and surgery)
LMWH prophylaxis:
- > 28 weeks if <3 RF
- from start if 4+ RF
- may require extra growth scans
- After delivery for at least 1 week (given after 24hr after CS or vaginal delivery)
