VTE Symptoms and Diagnosis Flashcards
White Clot
Atherosclerotic
- Artery
- High Flow / Pressure
Made up of platelets
- Treat with antiplatelet
ACS and Atherosclerotic Stroke
Red Clot
Thrombus
- Venous
- Low Flow / Pressure
Made up of RBC trapped with fibrin (Clotting Factors)
- Treat with anticoagulant
VTE and Cardioembolic Stroke
Virchow’s Triad
Hypercoagulable State
- Overreative clotting factors
- Pregnancy, Cancer
Endothelial Injury
- Disruption of plaque
Circulatory Stasis
- Unable to clear clotting factors
Venous Thromboembolism
Blood clot forms in vein
- May/May not embolize (Moves)
Deep Vein Thrombosis
Thrombosis occuring in deep vein (Leg, Arms, Mesenteric, Cerebral)
Pulmonary Embolism
Clot travels from bloodstream and blocks lung artery
DOAC
Direct Oral Anticoagulants
- Act on clotting factors in circulation
- Work quickly
- Do not require a co-factor
Warfarin
Indirectly impacts II, VII, IX, X
- Delayed action
What are the roles of Antiplatelets and Anticoagulants
Stabilizes clots so they do not embolize
- Creates enough time for body to break them down
Prevent clot growth/formation
Proximal DVT
Above knee
- Large veins, larger clots
- Increased chance of embolization
- 70-80% of DVTs
Distal DVT
Below knees
- Smaller veins, smaller clots
- Chance of growth into proximal system
- 20-30% of DVTs
Superficial Vein Thrombosis
Presents more on the surface
- Red, warm, and inflamed
High risk for future VTE
DVT
- Signs and Symptoms
Pain and tenderness
Swelling
Discolouration
Warmth
Superficial Venous Dilation
PE
- Signs and Symptoms
Increased Pulmonary Resistance (Right piushing into left)
- Right ventricular strain
- Right ventricular failure
SOB, Sudden cough
Clinical Significance
Size of embolus
- Larger are worse
Patient’s Cardiorespiratory Reserve
- Limited reserve = not much to tip them over the edge
Severity of PE
Massive (Admitted into hospittal)
- Unstable, in shock
Sub-Massive
- Signs of right ventricular strain
- Hemodynamically stable
Non-Massive (Can be managed as outpatient)
- Stable
Clinical Consequence of VTE
DVT
- Pain and discomfort in limb
PE
- Right ventricular failure
Probability for DTV/PE
Wells Criteria
Diagnostic Testing
- High probability
Confirmation Testing
Initiate anticoagulant while waiting for results
Diagnostic Testing
- Low or Intermediate
D-Dimer
D-Dimer
D-Dimer are products formed from fibrin degrading
Can be used to rule out VTE
- Not specific enough to diagnose VTE
Compression Ultrasonography
Used for mainly proximal
- Vein with gentle compression and no compressibility
Vein is not able to compress completely due to thrombus
Ventilation / Perfusion
Mismatch in perfusion and ventilation scans
- Means air is reaching areas of the lung while blood is not
CT Angiography
Main way of imaging
