Deep Vein Thrombosis and Pulmonary Embolus Flashcards Preview

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Flashcards in Deep Vein Thrombosis and Pulmonary Embolus Deck (22):
1

What is VTE?

Venous thrombo embolic disease
25,000 deaths/ye in UK

2

What is a thrombosis?

Intravascular solidification of blood constituents

3

What is an embolism?

Vascular obstruction at a site distant from the embolus origin

4

How common is DVT?

1 in 20 affected during lifetime
1 / 1000 people / yr

5

What is Virchaus Triad?

Alterations in blood flow
Alterations in blood constituents
Vascular endothelial injury

6

What are the 9 main acquired risk factors for VTE?

malignancy
surgery
trauma
immobility
obesity
pregnancy
HRT
previous thrombo-embolism
oral contraceptive pill

7

What are the 4 main inherited risk factors for VTE?

Factor V mutation
Prothrombin gene mutation
Protein 'S' or 'C' deficiency
Antithrombin III deficiency

8

How does DVT present?

Pain, tenderness, swellign, erythema, heat, venous engorgement

9

What are the differential diagnoses of DVT?

cellulitis, lymphoedema, muscle strain/tear, drug induced oedema, chronic venous insufficiency

10

How to investigate DVT?

D-dimer blood test
USS / Doppler
venogram

11

What is a D-dimer blood test?

method of investigating DVT. It looks at the products of thrombus fibrinolysis. Plasmin enzyme breaks down the fibrin mesh but it is unable to break the bonds between 1E and 2D units. The remaining protein fragment is a D-dimer

12

What are the problems with the D dimer test?

95% Sensitivity
50% Specificity

13

What are secondary results of DVT?

Venous insufficiency - hyper pigmentation, limb pain, swelling, dermatitis, ulcers, gangrene
Recurrent DVT
Pulmonary embolism

14

What is a pulmonary embolism (PE)?

Obstruction of a pulmonary artery or one of its branches (usually from DVT but can be from tumour or fat)

15

How does a PE present?

collapse
pleuritic chest pain
dyspnoea
tachypnoea
tachycardia

16

What is the treatment for a PE?

Uncomplicated PE - immediate anticoagulation with heparin
Major PE - systemic thrombolysis, catheter embolectomy with local thrombolysis, surgical embolectomy

17

Indications for thrombolysis?

Massive PE
Hypotension
Systemic hypo-perfusion

18

How can PE be prevented?

Calf pumping
LMWH
Early mobilisation

19

When should an IVC filter be used for PE treatment?

If PE with contraindication to anticoagulation or if recurrent PE despite adequate anticoagulation

20

What are NOACS?

Novel Oral Anticoagulants.
Developed because warfarin is awkward to use and cause a high degree of morbidity, mortality and cost.
They require minimal monitoring as can cause adverse effects through bleeding and interact with drugs which affect haemostasis

21

Name and describe 2 NOACS?

Dabigatran - direct thrombin inhibitor
Rivaroxaban and apixaban - direct factor Xa inhibitors

22

What are NOACS currently licensed for?

Prevention of VTE around surgery and being used as anticoagulation in atrial fibrillation