Flashcards in DVT Deck (11):
Sequelae of DVT?
-Chronic venous insufficiency
Aetiology of DVT?
Virchow's Triad: endothelial activation (i.e. injury), hypercoaguability, stasis.
How does stasis affected DVT risk?
Venous stasis due to immobilisation inhibits clearance and dilution of coagulation factors.
What are the acquired contributors to hypercoaguability?
-Blood dyscrasias, hyper viscosity
-Hormonal (pregnancy, OCP)
-Unilateral leg oedema, erythema, warmth and tenderness
-Palpable cord (thrombosed vein)
-Phlegmasia -cerulea dolens/-alba dolens with massive thrombosis
-Vascular: lymphangitis/obstruction; venous valvular insufficiency; arterial occlusive disease
-Ruptured popliteal cysts
What is the purpose of VTE treatment?
-Prevent clot extension
-Reduce risk of recurrence
-Treat acute lower limb ischaemia/ venous gangrene
-Limit late complications (e.g. chronic venous insufficiency, chronic thromboembolic pulmonary HTN).
Initial Rx VTE?
-LMWH (requires renal dosing)
Long term Rx VTE?
Warfarin (initiated with heparin overlap ==> dual for 5/52. Cease once INR >2.0 for 2/7).
Duration of anticoagulant treatment?
-1st DVT + transient RFx: 3 months
-1st DVT + ongoing RFx: consider indefinite therapy
-1st DVT + idiopathic: 6-12 months
-Recurrent DVT: indefinite