VTE Diagnosis and management - Dr Sunaina Miranda BW 2

Question 1

Case 1:

Factor V leiden personal history (Increases risk of estrogen mediated clots)

Answer 1

Question 2

What is the most specific symptom of DVT? (Unilateral lower limb oedema)

How do we Catergorize DVTs?

(think Transient vs persistent provoking factors Vs unprovoked)

Answer 2

1) Provoked - either Transient risks or persistent risk factor
2) Unprovoked

Question 3

Answer 3

Past History of DVT!

Question 4

Answer 4

Over 5000 deaths per year in Australia

Question 5

Answer 5

• Commence NOAC while waiting for CUS! Most correct
• • DVT is quite likely. Order Compression USS of left leg and await results (can use NOAC up front)

Question 6

How do we diagnose DVT?

What are the goals for treatment for Mrs a?

Whats your next steps?

Hoow many proximal DVTS will be associated with PE?

Answer 6

Goals of treatment:

1. Prevent extension of DVTor PE
2. Prevent Mortality associated with PE
3. Reduce post thrombotic syndrome
4. COnsider urgent treatment to p

Question 7

What are certain underlying risk factors when considering treatment?

What can cause increased APPT? (lupus anticoagulant)

(anti phospholipid syndrome= Clot+ screening bloods)- At risk of severe clots - require life long anticoagulant

Answer 7

Question 8

Thrombus location:

Think is it above or below knee - Thus above knee =Proximal (thus have 50% chance of having PE)

Answer 8

Question 9

Mrs A would you classify as provoked or unprovoked?

(unprovoked)

Answer 9

Question 10

What are your management options for Mrs A now?

• Commence treatment immediatley with NOAC and make follow up arrangements

Answer 10

Question 11

Anticoagulation for an isolated Distal DVT

How do we diagnose these?

How long should they be treated for? (6 weeks)

Answer 11

Question 12

When should you consider referral? (referral to specialist)

When should you send to ED immediatley

Answer 12

1. Possible iliofemoral DVT (entire leg)
2. Suspected thromboses of the deep veins

Question 13

What treatment would you treat with patients?

Answer 13

1. Either Apixaban or rivaroxaban (Rivaroxaban is once daily vs apixaban is 2 daily thus other patients)

Question 14

What are the guidelines for NOACS as for VTE treatment

Answer 14

Question 15

What are the preferred anticoagulant for intial treatment of DVT?

What is the mainstay for antiphopholipd syndrome

Answer 15

• Noacs
• Warfarin for

Question 16

What are the benefits of NOACs over warfarin?

Answer 16

• Reduces life threatening major bleeds and superior reduction in non major clinically relevant bleeding (over warfarin)

Question 17

What are the differences in NOACS vs Warfarin in the bleeding type?

Answer 17

If GI issues - Bleeding/malignancy

Question 18

How long will you treat mrs A with NOACs

Answer 18

Question 19

Initial treatment

3 months!!! (any longer only increases bleeding risk

Answer 19

Question 20

Management of DVT (minimun 3 months)

List 5 components of managemnt:

Answer 20

1. All patients anticoagulate for 3 months
   2.

Question 21

Treatment options for Mrs A

Remember loading dose for NOACs - which is usually double there dose,

Answer 21

Question 22

Who should recieve 3 months vs indefinite?

What is the cumulative rate of DVT PE recurrence after initial unprovoked DVT?

Answer 22

Question 23

Risk of recurrent VTE

Patients with cancers and consistent provoking risk factors

What are some secondary estimators for recurrent VTE?

Answer 23

Question 24

List risks of major bleeding: (think HAS BLED)

Answer 24

Question 25

Older vs younger patient and VTE

Answer 25

Question 26

What should you do to manage patients with unprovoked DVT?

Outline the treatment/management of DVT

Answer 26

Question 27

Overall Management for Mrs A?

What should we have done? When should we review her? what other tests after three months should we study?

Answer 27