DVT and PE

Question 1

Presentation of DVT?

Answer 1

Painful 
Swollen limb 
Redness
Heat 
Tenderness along vein 
Sub-acute development 
No other obvious cause

Question 2

Presentation of PE?

Answer 2

Sudden SOB with pleuritic pain
+- collapse +- heamoptysis +-Hypoxia and tachycardia
BP may be low

Question 3

Scoring system for PE probability?

Answer 3

WELLS Score

Question 4

What is D-Dimer?

Answer 4

Breakdown product of cross-linked fibrin

Question 5

If a D Dimer has a high negative result?

Answer 5

->98% for VTE

No further investigations needed?

Question 6

If there is a moderate to high probability a patient has a VTE what do they need?

Answer 6

Scan

Question 7

Scan done for PE?

Answer 7

CT pulmonary angiogram (CTPA)

Question 8

Severity assessment for

• DVT
• PE?

Answer 8

• Almost always symptomatic, clinical assessment, not very serious
• PESI score (PE severity index score) because for PEs there can be a risk of deterioration and death as PEs put strain on right heart

Question 9

What is PTS?

Answer 9

Post thrombatic syndrome

Question 10

Characteristics of PTS?

Answer 10

Pain 
Oedema 
Hyperpigmentation 
Eczema 
Varicose collateral veins 
Venous ulceration

Question 11

When does PTS occur?

Answer 11

Approx 5 years after treatment for VTE, in 1/3 of patients

Question 12

What is thought to be associated with PTS?

Answer 12

DVT-induced damage to valves in the deep veins and valvular reflux leading to venous hypertension are thought to be associated with PTS.4

Question 13

Management of DVT?

Answer 13

Oral anticoagulation

highly specialised centres could consider thrombolysis

Question 14

PE management?

Answer 14

High risk 
Thrombolysis 
then anticoagulation 
Intermediate risk= 
Oral anticoagulation

Question 15

What is thrombolysis othere name?

Answer 15

Fibrinolysis

Question 16

What does thrombolysis do?

Answer 16

Aggressive clot destruction

Question 17

Examples of direct anti-coagulant?

Answer 17

Apixaban
Rivaroxaban
1st line therapy

Question 18

Only time warfarin hsould be used?

Answer 18

Metal valve

Anti-phospholipid syndrome

Question 19

Vitamin K antagonist example?

Answer 19

Warfarin

- rarely used now

Question 20

Low molecular wight heparin Injections?

Answer 20

Used in patients with active cancer and PE

Question 21

Examples of anti-coagulants to treat with?

Answer 21

Direct oral anticoagulant
Vitamin K antagonist
Low molecular weight heparin injection

Question 22

How long to treat provoked VTE with reversible factor for?

Answer 22

3-6 months

Question 23

Duration to treat provoked VTE with irreversible factors?

Answer 23

3-6 months
or
Lifelong depending on patient factors

Question 24

Duration to treat unprovoked VTE with

• Transient risk factor
• Non-major transient risk factor
• Woman with unprovoked VTE
• Man with unprovoked VTE?

Answer 24

• 3 months
• 3 months or long term
• Long term
• Long term

Question 25

Advice for man with unprovoked VTE?

Answer 25

Recommend life long anti coagulants ubless bleeding issue

Question 26

Scoring system to see whether to keep patients on anti-coagulants?

Answer 26

HERDOO-2

Question 27

Define DVT?

Answer 27

Deep Vein Thrombosis | Clot (thrombus)formed in the deep venous circulation (usually legs) but can be anywhere

Question 28

Define PE?

Answer 28

Pulmonary Embolism | Thrombus (clot) that has embolised (travelled) and lodged in the pulmonary circulation

Question 29

Define PTE?

Answer 29

Venous Thromboembolic Disease | Covers both DVT and PE

Question 30

Where DVTs form?

Answer 30

Thrombi form predominately in venous valve pockets and other sites of presumed stasis

Question 31

Where PEs form?

Answer 31

Thromboemboli detach and travel through the right side of the heart to block vessels in the lungs

Question 32

What does distal vein thrombosis refer to?

Answer 32

DVT of the calves

Question 33

Proximal vein thrombosis?

Answer 33

DVT of the popliteal vein or femoral vein- closer to the heart

Question 34

Definition of DVT in depth?

Answer 34

Formation of thrombi within the lumen of the vessels that make up the deep venous system

Question 35

3 abnormalities that promote thrombus formation?

Answer 35

``` Hypercoagulable state (Abnormalities in blood clotting components) Circulatory stasis (Abnormalities in blood flow) Endothelial Injury (abnormalities in blood vessel wall) ```

Question 36

Examples of conditions which have abnormalities in blood clotting components?

Answer 36

``` Malignancy Pregnancy and peripartum period (short period before, during and after giving birth) Oestrogen therapy Inflammatory bowel disease Sepsis Thrombophillia ```

Question 37

Diseases associated with abnormalities in blood vessel wall?

Answer 37

Venous disorders Venous valvular disease Trauma or surgery Indwelling catheters

Question 38

Conditions associated with abnormalities in blood flow?

Answer 38

Left ventricular dysfunction Immobility or paralysis Venous insufficiency or varicose veins Venous obstruction from tumour, obesity or pregnancy

Question 39

Risk factors for VTE general?

Answer 39

Cancer | Inflammatory diseases

Question 40

Exposing risk factors for VTE?

Answer 40

``` Surgery Trauma Acute medical illness Acute heart failure Acute respiratory failure Central venous catheterisation ```

Question 41

Predisposing risk factors for VTE?

Answer 41

``` History of VTE Chronic heart failure Advanced Age Varicose veins Obesity Immobility or paresis Myeloproliferative disorder Pregnancy/ peripartum period Inherited or acquired thrombophilia Hormone therapies Renal insufficiency ```