DVT

Question 1

DVT RF

Answer 1

Previous DVT, >60, surgery, obesity, prolonged travel, acute medical illness, cancer immobility, thrombophilia, pregnancy

Question 2

PE suspected in how many people who die from it

Answer 2

Less than half

Question 3

DVT presentation

Answer 3

Signs of DVT only present in 15%

• Limb pain and tenderness along line of deep veins
• Unilateral swelling of calf or thigh (can be bilateral)
• Pitting oedema
• Distension of superficial veins
• Increase in skin temperature
• Skin discolouration
• Palpable cord
• Cellulitis and DVT interrelated

Question 4

DVT Differentials

Answer 4

Trauma, superficial thrombophlebitis, post-thrombotic syndrome, peripheral oedema, HF, venous or lymphatic obstruction, cellulitis

Question 5

If DVT suspected and likely two level DVT Wells’ score?

Answer 5

USS and D-dimer

• If both positive, DVT
• If only USS positive, DVT
• If only D-dimer positive, repeat USS in 1 week

Question 6

If DVT suspected and unlikely two level DVT Wells’ score?

Answer 6

D-Dimer

• If negative, DVT excluded
• If positive, USS to confirm

Question 7

Wells’ DVT score

Answer 7

Active cancer, paralysis, recently bedridden, localised tenderness, entire leg swollen. calf swelling by more than 3cm compared with other leg, pitting oedema confined to symptomatic leg, collateral superficial veins, previous DVT

• Subtract 2 if alternative cause is considered at least as likely
• DVT likely if score is 2 or more

Question 8

Further Ix for unprovoked DVT

Answer 8

• If under 40 look for thrombophilia, if over 40, look for cancer
• Offer all patients with unprovoked DVT or PE Ix for cancer (physical exam, CXR, bloods (FBC, calcium, LFTs) and urinalysis. CT as well if over 40
• Antiphospholipid antibodies
• Hereditary thrombophilia

Question 9

Confirmed DVT Management

Answer 9

• LMWH or fondaparinux (UFH for CKD)
• For at least five days
• Oral anticoagulant for three months
• After 3 months assess risks and benefits of continuing

Question 10

Other management for DVT

Answer 10

• Do not offer stockings unless to manage symptoms

- Offer temporary inferior vena caval filters if anticoagulation treatment not possible or in recurrent DVT

Question 11

DVT Prognosis

Answer 11

-Often returns

Question 12

Post thrombotic syndrome?

Answer 12

-Chronic, venous hypertension which may result in pain, swelling, hyperpigmentation, dermatitis, levers, gangrene, lipodermatosclerosis