VTE (DVT + PE) Flashcards
Thrombophilias are conditions that predispose patients to develop blood clots. Name a common one.
What’s a common association of antiphospholipid syndrome? (thrombophilia)
recurrent miscarriage
Give four risk factors for DVT.
if a patient admitted to hospital is assessed as having increased risk of VTE, what drug can be given as prophylaxis?
low molecular weight heparin e.g enoxaparin
what are the contraindications for prophylaxis with low molecular weight heparin?
- active bleeding
- already on warfarin or a DOAC
compression stockings can be used for VTE prophylaxis, what’s the contraindication for them?
- significant peripheral arterial disease
four common symptoms of DVT?
how would you measure for ‘significant’ swelling of the calf?
- measure circumference 10cm below tibial tuberosity
- more than 3cm difference between calves is significant
What scoring system predicts a patient’s likelihood of having/developing a DVT?
-
what blood measurement is almost always raised in DVT?
d-dimer
(d-dimer = fibrin degradation product, produced when clots are lysed)
what’s required to diagnose DVT?
doppler ultrasound
(like normal ultrasound but uses the doppler effect to depict blood flow etc)
If a diagnosis of DVT is negative with a Doppler ultrasound, under what criteria does NICE recommend another scan?
- positive D-dimer test
- Wells score 2 or greater
- repeat scan in 6-8 days
(note that other conditions such as pneumonia and pregnancy can cause a positive d-dimer)
how is a PE diagnosed? (two ways)
- CT pulmonary angiogram (CTPA)
- ventilation-perfusion (VQ) scan
what’s the initial management for a patient with suspected or confirmed DVT or PE?
if a patient has a symptomatic iliofemoral DVT (with symptoms lasting <14 days), what treatment should be considered?
- catheter-directed thrombolysis
(catheter inserted under X-ray guidance, thrombolysing factors applied directly onto clot)
a patient has antiphospholipid syndrome, what is first line long-term drug treatment for VTE?
What’s the classic triad of symptoms for Budd-Chiari syndrome?
a patient presents with VTE-like symptoms, what score can be used to predict their risk of this actually being caused by a VTE?
a patient is admitted and assessed as having a high risk of VTE, what should be done?
when would you not give a high-risk VTE patient LMWH?
give an example of a LWMH
what test can be done if you are concerned about VTE but they’re deemed to be at low risk?
what’s the diagnostic test for a PE?
what two drugs can be given for initial management of a PE?
a patient has antiphospholipid syndrome, what drug should be given as initial management for a PE?
what drugs can be given for long-term anticoagulation after a PE?
what’s first line treatment for long term management of PE in pregnancy or cancer?
what is a DOAC an alternative to and what are the three main ones?
give three drugs that can be used in treatment of a massive PE
in which two ways can thrombolytics be administered to treat a massive PE?
