VTE and PE ☺️ Flashcards
VTE risk factors
- personal
- medical
- medication
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
PE presentation
Pleuritic pain SOB Haemoptysis High HR, RR Fever Crackles
Describe PERC (PE ruleout criteria)
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
Describe the 2 level Wells score
3 points
- clinical presentation of DVT (leg swelling and pain on palpation)
- alt diagnosis less likely
- 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
Interpretation of Wells score and management
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
Management of PE
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