Week 5 - Deep Vein Thrombosis and Pulmonary Thromboembolism Flashcards

1
Q

What is the main reason for venous thrombosis?

A

stasis and high risk of coagulability

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2
Q

What is a red vs white thrombus?

A

red is found in the venous system, and mostly RBC’s and fibrin.
white is found mostly in arterial system, and made of platalets and fibrin.

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3
Q

What is an arterial thrombus most commonly caused by?

A

rupture of atherosclerotic plaque causing thrombus

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4
Q

What is the main fates of arterial and venous thrombus?

A

arterial - ACS, ischaemic stroke and claudification of limbs
venous - DVT and pulmonary embolism

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5
Q

How does DVT occur?

A

in deep venous system. valves become incompetent so stasis in vessels, leading to thrombus formation.
May be caused by infection by IV use, causing thrombus

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6
Q

What are our main concerns regarding DVT?

A

pain, embolise to lungs, prevent outflow from heart

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7
Q

What are signs and symptoms of an embolism?

A

unilateral oedema, prominent superficial veins (not varicose), calf tender, knawing pain, warm, red

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8
Q

How do you diagnose embolism?

A

assess patient and history. then use pre-test probability scores.

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9
Q

What pre-test probability scores are available for embolism?

A
  • DVT wells score. If low risk, do d-dimer test.
  • if high risk on wells score OR positive d-dimer test, do compression ultrasound
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10
Q

How does a DVT wells score work?

A

9 factors contribute. if1 or less, low risk. if 2 or above, high risk of DVT. do compression ultrasound.

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11
Q

What is the “gold standard” test for DVT?

A

compression ultrasound test

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12
Q

What are positives and negatives of D dimer test?

A

shows breakdown of fibrin following fibrinolysis. its very sensitive for venous thromboembolism, but not specific.
positive result may be caused by trauma, malignancy, sepsis, bleeding, cancer etc

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13
Q

What are symptoms of pulmonary thromboembolism?

A

pleuritic chest pain, breathless, tachycardia, blood in sputum,

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14
Q

What are signs of pulmonary thromboembolism?

A

dyspnoea, tachycardia, shock, collapse, low BP, sudden death

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15
Q

What do we use to diagnose pulmonary thromboembolism?

A

same as pulmonary DVT.
wells score, d dimer if negative.
if indicated, imaging with isotope v/q scan and CT pulmonary angiogram

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16
Q

What is the wells score result for high risk and low risk of PE?

A

low risk if 4 or less. high risk is 4.5 or above.

17
Q

How do you treat pulmonary thromboemblism?

A

anticoagulation for months or even life long.

18
Q

What different anticoagulant options are there for PE treatment?

A

parenteral - IV dalteparin (low molecular weight heparin) or IV unfractionated heparin in renal failure patients
enteral - direct oral anticoagulants - rivaroxaban or dabigataran. warfarin.

19
Q

What is the first line of treatment in PE?

A

first parenteral anticoagulant, then warfarin or direct oral anticoagulant

20
Q

What are potential long term consequences of DVT?

A

post thrombotic syndrome - damage to venous valves. swelling, discomfort, ulceration. 20-60% incidence in 2 years

21
Q

What are potential long term consequences of PE?

A

most recover fully. may lead to hypertension. treated by removing blood clot