VTE and PE ☺️ Flashcards

1
Q

VTE risk factors

  • personal
  • medical
  • medication
A
Age
Obesity
FHx
Pregnancy and postnatal period
Immobility/hospitalisation/anaesthesia/surgery

Malignancy
Thrombophilia, APS, Polycythemia, Sickle cell
Nephrotic syndrome
HF

COCP, HRT, raloxifene/tamoxifen
Antipsychotics

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2
Q

PE presentation

A
Pleuritic pain
SOB
Haemoptysis
High HR, RR
Fever
Crackles
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3
Q

Describe PERC (PE ruleout criteria)

A

Used for patients that are unlikely to have a PE but you would like more reassurance

ALL MUST BE NEGATIVE FOR PE TO BE RULED OUT

  • Age 50+
  • HR 100+
  • SaO2 U94%
  • Past DVT, PE
  • Recent surgery/trauma in past 4wks
  • Haemoptysis
  • Unilateral leg swelling
  • O use
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4
Q

Describe the 2 level Wells score

A

3 points

  • clinical presentation of DVT (leg swelling and pain on palpation)
  • alt diagnosis less likely
  1. 5 points
    - HR 100+
    - immobilised for 3+days/surgery in past month
    - Past DVT/PE

1 points

  • haemoptysis
  • malignancy

PE likely - 4+
PE unlikely - 4 or less

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5
Q

Interpretation of Wells score and management

A

4+ = IMMEDIATE CTPA

  • if delayed, give DOAC
  • if CTPA +ve => PE diagnosis
  • if CTPA -ve => proximal leg vein USS if DVT suspected

4 or under = D DIMER

  • if +ve => as above
  • if -ve => stop DOAC, alt diagnosis
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6
Q

Management of PE

A

Provoked - 3 months (add 3 more months in active cancer)
Inprovoked - 6 months

1st line DOAC - apixaban/rivaroxaban
2nd line - LMWH followed by dagabitran/edoxaban

If renal impairment => LMWH/unfractionated heparin
If APS => LMWH followed by warfarin

If haemodynamically instable/MASSIVE PE => thrombolysis

If on max anticoagulation and repeat PEs => IVC filters

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