DVT - case study in Acute

Question 1

Questions to ask about for DVT

Answer 1

• When was this noticed?
• Chest pain?
• SOB?
• Insect bites/trauma to leg?
• Unilateral pain?
• Mobilising?
• Cancer?
• Previous DVT/PE?
• Recent surgery/immobilisation for 3 days?
• Pregnancy
• Medication?

Question 2

Algorithm for DVT suspected?

Answer 2

• First calculate Wells score
• If score 2 points or more = likely
• If 0/1 = unlikely
• Likely –> vein USS leg if results not within 4 hours, offer D-dimer, interim anticoag and USS within 24hrs
• Unlikely –> D-dimer, if cannot have results within 4hrs, interim anticoag
  If +ve –> offer USS within 4hrs, if not continue anticoag and get one in 24
  If -ve D dimer = not DVT

Question 3

Tests for DVT

Answer 3

• D-dimer
• ECG - PE?
• FBC, U&E, LFT
• PT & APTT
• USS leg veins

Question 4

Treatment for DVT

Answer 4

• Apixaban or Rivaroxaban (if not LMWH) within 4 hrs
• If use LMWH follow with dabigatran or edoxaban after 5 days
• another option is LMWH and warfarin for 5 days
• Long term treatment is oral anticoagulant eg DOAC, dabigatran, or warfarin
• Treatment is for 3 months in provoked (can find cause) if unprovoked may be longer

Question 5

Preventative measures for DVT

Answer 5

• Mobilising after op
• Compression stockings
• Intermittent pneumatic compression
• LMWH for those at risk in hospital

Question 6

What is part of DVT Wells score?

Answer 6

• Cancer = 1
• Bedridden more than 3 days or major surgery within 12 weeks = 1
• Calf swelling more than 3cm to other leg = 1
• Collateral superficial veins visible = 1
• Entire leg swollen = 1
• Localised tenderness along deep veins = 1
• Pitting oedema confined to affected leg = 1
• Paralysis, paresis or recent plaster of lower extremity = 1
• Previous DVT documented =1
• Alternative diagnosis as or more likely = -2