Deep Vein Thrombosis Flashcards Preview

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Flashcards in Deep Vein Thrombosis Deck (19)
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1
Q

Define DVT?

A

Formation of a thrombus within the deep veins (most commonly in the calf or thigh)

2
Q

What are the causes of DVT?

A

Deep veins in the legs are more prone to blood stasis, hence clots are more likely to form

3
Q

What are the risk factors for DVT?

A
COCP (combined oral contraceptive pill)
Post-surgery
Prolonged immobility 
Obesity 
Pregnancy
Dehydration
Smoking 
Polycythaemia
Thrombophilia 
Malignancy
4
Q

What is the epidemiology of DVT?

A

Very Common

Especially in hospitalised patients

5
Q

What are the presenting symptoms of DVT?

A

Swollen limb

May be painless

6
Q

What are the signs of DVT on physical examination?

A
Local Erythema, Warmth and swelling
Measure the leg circumference 
Varicosities (swollen/tortuous vessels)
Skin colour changes
Homan's sign
7
Q

What is Homan’s sign?

A

Forced passive dorsiflexion of the ankle causes deep calf pain

8
Q

How is risk stratified for DVT?

A

Using the Wells Criteria

If the score is 2 or more it is classifed as high risk

9
Q

What would you do to examine for PE?

A

Check resp rate
Pulse oximetry
Pulse rate

10
Q

What is the gold standard investigation for DVT?

A

Doppler Ultrasound

11
Q

How does Impedance Plethysmography work for DVT?

A

Changes in blood volume results in changes of electrical resistance

12
Q

What bloods would you do for a DVT?

A

D-Dimer which can be used as a negative predictor

Thombophilia screen if indicated

13
Q

What investigations would you do if PE is suspected?

A

ECG
CXR
ABG

14
Q

What is the management plan for DVT?

A

Anticoagulation
IVC Filter
Prevention

15
Q

What do you do for anti-coagulation in DVT?

A

Heparin whilst waiting for warfarin to increase INR to the target range of 2-3
DVTs that don’t extend above the knee may be observed and anticoagulated for 3 months
DVTs that extend beyond the knee require anticoagulation for 6 months
Recurrent DVTs require long-term warfarin

16
Q

When would you use an IVC filter?

A

If anticoagulation is contraindicated and there is a risk of embolism

17
Q

What would you do to prevent DVTs?

A

Graduated compression stockings
Mobilisation
Prophylactic heparin (if high risk e.g. hospitalised patients)

18
Q

What are the possible complications of DVT?

A

PE
Venous infarction (phlegmasia cerulea dolens)
Thrombophlebitis (results from recurrent DVT)
Chronic venous insufficiency

19
Q

What is the prognosis for patients with DVT?

A

Depends on extent of DVT
Below-knee DVTs have a good prognosis
Proximal DVTs have a greater risk of embolisation