Haem Flashcards
(19 cards)
How would you identify a superficial thrombophlebitis?
- Symptoms: Pain, tenderness, induration and/or erythema along the course of a superficial vein.
- Venous ultrasound to exclude Deep vein thrombisis
RISK factors for superficial thrombophlebitis
- Varicose veins
- IV cannulation.
- Malignancy
- Hypercoagulable states - a) acquired or inherited coagulopathy b) PCV c) thrombocytosis
- Pregnancy
- Oestrogen
- Obesity
How would you differentiate a high risk thrombophlebitis from a low risk one?
- Greater than 5cm is high risk (less than 5 is low)
- Proximity to deep venous system (less than or equal to 5cm from saphenopopliteal or saphenofemoral junction)
- DVT risk factors
Management of a superficial thrombophlebitis
- NSAID - ibuprofen 400mg 8hrly orally
- Enoxaparin 40mg daily for 4-6 weeks. (45 days) (esp if thigh veins) OR Monitoring for VTE
- Extremity elevation (Waist level)
- Warm or cool compresses
- Compression therapy
- Encourage patient to remain ambulatory if possible
- If patient requires anticoagulation - baseline D-dimer and again at 45 days
- Safety netting - extension, increased swelling, concerned - for review
- No abx unless signs of infection
- Review in 2 days
What are the risk factors for DVT?
- Long term immobilisation
- Recent surgery
- Past history of DVT/PE
- Oestrogen therapy
- Malignancy
- Pregnancy
- Hypercoagulability (1. Acquired or inherited coagulopathy 2. PRV 3. Thrombocytosis
- Family hx
- Obesity
- Dehydration
- Recent plane travel
What are the clinical features of a DVT?
- Dilated, prominent superficial veins
- Unilateral swelling
- Warmth and erythema
4, Unilateral difference in calf or thigh diameter
- Pitting oedema
- Tendeness and pain along the involved major vein
HOMANs sign (Don’t elicit as can dislodge) - pain on sharp dorsiflexion of the foot
What proportion of DVT’s go onto cause PE?
Distal to popliteal vein - 5%
Proximal to popliteal vein - 50%
In which venous systems do DVT occur?
- Deep veins of LL
- Axillosubclavian venous thrombosis
- Ovarian and Pelvic veins (pelvic pain and swollen upper thighs)
- Mesenteric veins
- Cerebral veins
Investigations in DVT?
Doppler ultrasound of lower limb venous system
If negative - repeat in one week.
D-Dimer can exclude PE if the probabilty is low
Difference between distal and proximal DVT
Below or above popliteal vein
Before starting anticoagulation therapy - any tests?
INR
APTT
Full blood count
Urea Electrolyte creatinine
Liver function
BHCG for women of childbearing age
General management of DVT
- Anticaogulation
- Graduated compression stocking
- Pain relief
- Encourage patients to mobilise as soon as possible
- Monitor progression - progress of clot
- Advise patient about red flags - safety net
Proximal DVT?
Must have anticoagulation
Pregnant woman or cancer and DVT? HOw does this affect anticoagulation
CANT USE NOAC
must use parenteral
Whats the dose parenteral anticoagulation in a DVT
Enoxaparin 1mg/kg twice a day IF eGFR is over 30
If eGFR is less than 30 - use Enoxaparin 1mg/kg daily
USE FOR THREE MONTHS AND REVIEW
If Proximal DVT - options for anticoagulation?
- NOAC - Apixaban 10mg bd for seven days then continue at 5mg bd.
Anticoagulate for three months
NOAC should NOT be used in severe renal impairment
then go to enxoaparin 1mg/kg daily for three months
What about graduated compression stockings in DVT?
Commence AFTER 2 weeks of anticoagulation
Can reduce risk of post thrombotic syndrome
Needs to be fitted by a professional
What are the goals with ambulation post DVT?
Ambulate as soon as possible - Mobilise to point of pain
What are you monitoring for in terms of DVT progression?
Complications of DVT and of anticoagulation
- clot extension
- recurrence
- emoblisation
- Post thrombotic syndrome
- Chronic thromboembolic hypertension
- bleeding
- thrombocytopaenia
What are features of post thrombotic syndrome
Limb pain, swelling and redness following a DVT
