Condition- Deep Vein Thrombosis

Question 1

What is deep vein thrombosis?

Answer 1

Formation of a thrombus within the deep veins (most commonly in the calf or thigh) –> impaired venous return –> swelling in legs

Question 2

List the three factors that affect the risk of thromboembolic events

Answer 2

VIRCHOW’S TRIAD:

1. Stasis
2. Hypercoagulability
3. Endothelial Injury

Question 3

List some of the risk factors for developing DVT

Answer 3

• Recent surgery
• Prolonged Immobility- recent hospitalisation, long-haul flights (+ dehydration)
• Active Cancer
• Lower extremity trauma
• Age
• Pregnancy
• Obesity
• Synthetic oestrogen (pro-inflamm)
• FHx/ PMHx
• Factor V Leiden, Protein C/S deficieny, antithrombin deficiency

Question 4

Describe some of the presenting symtpoms of someone with DVT (w/o PE)

Answer 4

• Unilateral Calf swelling
• Mild fever
• May be painless- but can have localised pain

Question 5

List some of the signs of DVT observed upon inspection of the legs

Answer 5

• Local erythema, swelling, varicosities, skin colour changes

Question 6

List some signs of DVT on palpation of the legs

Answer 6

• Tenderness
• Warmth
• Pitting Oedema
• Increased leg circuference 10cm inf of tibial tuberosity
• Homan’s sign (pain on forced passive dorsiflexion)

Question 7

State a noticeable complication of DVT that is visible in the legs?

Answer 7

phlegmasia cerulea dolens

Whole leg is swollen and purple and appears ischaemic

Arterial inflow is affected

Question 8

Which criteria is used to asses a persons DVT risk score?

Answer 8

WELLS CRITERIA

Question 9

What is Homan’s sign?

Answer 9

Forced passive dorsiflexion at the ankle causes deep calf pain in DVT.

Question 10

Which investigations could you order to investigate if someone has DVT?

Answer 10

1. Well’s Criteria: Score of >2 is high
2. D-dimer levels: Elevated. Not useful for pregnancy as it’s naturally high
3. GOLD STANDARD: Duplex Ultrasound: Doppler and Vein compression- inability to fully compress lumen, reduced blood flow

Question 11

Which investigations could be ordered if PE is suspected?

Answer 11

• ECG
• CXR
• ABG

Question 12

How would you manage someone with DVT with no PE risk or bleeding?

Answer 12

• Anticoagulants: Low molecular weight heparin (LMWH) whilst waiting for warfarin to bring INR to normal range (2-3)
• IVC filter
• Prevention:
  
  • Graduated Compression Stockings
  • Mobilisation
  • Prophylactic heparin

Question 13

How long is the treatment of Warfarin for someon with DVT? Under what ciumstances might you extend the course?

Answer 13

• Normally at least 3 months
• Then do a follow up
• Extend to 6 months if:
  
  • Unprovoked proximal DVT
  • Low bleeding risk
  • High VTE risk
  • Active cancer

Question 14

List some of the potential complications of DVT

Answer 14

• Pulmonary embolisn
• Venous Infarction- phlegmasia cerulea dolens
• Thrombophlebitis
• Chronic Venous insufficiency

Question 15

Describe how the prognosis of DVT varies according to the site of the thrombus

Answer 15

• Below-knee DVTs have a GOOD prognosis
• Proximal DVTs have a greater risk of embolisation