Flashcards in Thrombotic disorders Deck (14):
What are the three main veins where a DVT is likely to occur?
Femoral vein, popliteal vein, tibial vein
Outline Virchows triad
Virchow's triad describes the three broad categories of factors that are thought to contribute to thrombosis.
State 3 risk factors for thrombosis
Long haul flights
What are the clinical presentations of a thrombosis?
Unilateral calf swelling/heat/pain/redness/hardness
Differential diagnosis: cellulitus, Baker's cyst, muscular pain
POTENTIALLY FATAL (approx. 1000 deaths/year)
Why would a doppler ultrasound be aa good diagnostic tool for thrombosis?
Produces real-time 2D image of soft tissue stuctures
Colour duplex shows velocity and direction of blood flow
Veins non-compressible by U/S probe
How is the d-dimer test used in diagnosis of thrombosis?
Likelihood of having a DVT can be assessed using the Wells risk score & D-dimers test
D-dimers indicate activation of clotting calscade
Low Wells score & negative d-dimer test have high negative predictive value (>99% NPV)
What is the initial treatment for thrombosis?
Therapeutic LMW Heparin (Tinzaparin or enoxaparin)
If renal impairment anti-coag with IV unfractionated heparin
What subsequent treatment for thrombosis would you give?
Load patient with oral warfarin for 3-5 days
Stop LMW Heparin once INR > 2 for 2 days
if 1st DVT in femoral or iliac- 6 months warfarin
if 2nd DVT/PE- lifelong warfarin
Maintain INR between 2-3
What are the clinical signs of a PE?
Pleuritic pain (chest pain)
In massive PE: collapse, syncope, death
On examination: Tachycardia, tachypnoe, hypotensive
Which three investigations may be of interest when dealing with a suspected PE?
1. v/q scan
3. Chest X-ray ( although this is normal as it measure airation)
What are the likely outcomes of PE?
5% mortality, 4% develop pulmonary hypertension
Death in 10-30% in-patients
Up to 60% of patients have a micro-emoboli at post mortem
What treatment is given in the case of a massive PE?
Treat signs of shock
Thrombolysis and IV Heparin
What treatment is given in the case of a standard PE?
LMW Heparin injections e.g. Tinzaparin (better if underlying cancer)
Warfarin 6 months