VTE and PE ☺️

Question 1

VTE risk factors

• personal
• medical
• medication

Answer 1

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

Question 2

PE presentation

Answer 2

Pleuritic pain
SOB
Haemoptysis
High HR, RR
Fever
Crackles

Question 3

Describe PERC (PE ruleout criteria)

Answer 3

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

Question 4

Describe the 2 level Wells score

Answer 4

3 points

• clinical presentation of DVT (leg swelling and pain on palpation)
• alt diagnosis less likely

1. 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

Question 5

Interpretation of Wells score and management

Answer 5

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

Question 6

Management of PE

Answer 6

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