VTE

Question 1

List risk factors of VTE

Answer 1

• cancer/maligancy
• varicose veins
• long flights
• hx of VTE
• opioid misuses

Question 2

What happens in the body during pulmonary embolism

Answer 2

• in DVT a blot clot forms in the the deep veins of the legs
• the clot breaks off, travels through the blood stream to the right side of the heart, then into the pulmonary arteries, which supplies blood to lungs

Question 3

Symptoms of DVT?

Answer 3

• throbbing pain in one calf/thigh
• redness
• swollen veins
• warm skin
• swelling in one leg

Question 4

Symptoms of PE

Answer 4

• difficulty breathing
• chest pain when breathing in
• coughing up blood

Question 5

80% of PE start as DVT - true or false

Answer 5

True

Question 6

Virchows traid is a contributing risk factor to PE, what 3 factors does it include?

& other risk factors of PE

Answer 6

• hypercoaguability
• endothelial injury
• hemodynamic changes

• oestrogen
• pregnancy

Question 7

Clinical manifestations of PE

Answer 7

• breathlessness
• tachycardia
• pleuritic chest pain
• haemopytsis
• syncope
• hypotension
• confusion

Question 8

What would be the management for someone with no renal impairment, cancer, anti phospholipid syndrome or haemodynamic instability

Answer 8

1st line: Apixaban or Rivaroxaban

2nd line:

• LMWH for 5 days, then edoxaban or dabigatran

OR

• LWMH + VKA for 5 days or when INR is 2, then give VKA alone

Question 9

What would be the management for renal impairment?

Answer 9

If CrCl - 15-50, give one of the following:
• apixaban
• rivaoxaban
• LMWH for 5 days then edoxaban or dabigatran
• LMWH or UFH + VKA for 5 days or until INR of 2, then continue VKA

If CrCl is <15
• LMWH
• UFH
• LMWH or UFH + VKA for 5 days or until INR of 2, then continue VKA

Question 10

What would be the management for active cancer?

Answer 10

One of the following

• DOAC
• LMWH
• LWMH + VKA for 5 days or when INR is 2, then give VKA alone

Question 11

What is the management for Anti phospholipid syndrome

Answer 11

LWMH + VKA for 5 days or when INR is 2, then give VKA alone

Question 12

Does unprovoked VTE require cancer investigations?

Answer 12

No

Question 13

Gratuated compression is used for prophylactic, in which patients is it CI

Answer 13

• stroke
• PAD
• dermatitis
• leg oedema
• neuropathy

Question 14

What is the prophylactic management of VTE for someone undergoing going elective hip surgery (post surgery)

Answer 14

• LMWH for 10 days, followed by Aspirin - 28 days OR
• LMWH for 28 days, with stockings or Rivaroxaban

Question 15

What is the prophylactic management of VTE for someone undergoing going elective knee surgery (post surgery)

Answer 15

• Aspirin for 14 days OR
• LMWH for 14 days with stocking or rivaoroxaban

(Low doses of Aspirin)

Question 16

How long can prophylactic be extended for, for abdominal cancer surgery

Answer 16

28 days post surgery

Question 17

How long can prophylactic be extended for, for spinal surgery

Answer 17

30 days post surgery

Question 18

In pregnancy how many times is the risk increase for DVT

Answer 18

4

Question 19

In pregnancy which leg is most affected by DVT

Answer 19

Left side

Question 20

In pregnancy does d-dimer level increase or decrease

Answer 20

Increase as the pregnancy progresses

Question 21

What is the prophylaxis of DVT is normal pregnant women in hospital

Answer 21

LMWH until discharge

Question 22

What is the prophylaxis of DVT is normal pregnant women in hospital who have had miscarriage or termination?

Answer 22

LMWH, 4-8 hours after event, for 7 days

Question 23

Pregnant women at high risk of haemorrhage or VTE, should be given

Answer 23

UFH

Question 24

If reduced mobility- what would be the prophylactic management first line

Answer 24

Graduated compression socks

Question 25

What is the treatment management for DVT in pregnancy

Answer 25

LMWH until suspected VTE is excluded

Question 26

What is the duration of long term anticoagulation of secondary prevention when VTE is provoked

Answer 26

• 3 months • 3-6 months in cancer patients

Question 27

What is the duration of long term anticoagulation of secondary prevention when VTE is unprovoked

Answer 27

• beyond 3 months • beyond 6 months in cancer

Question 28

Is Aspirin licensed in VTE

Answer 28

No

Question 29

When choice comes between edoxaban and dabigatran - if the patient has CrCL of 30 and over which would you give

Answer 29

Dabigatran

Question 30

What is the treatment dose in VTE for Rivaroxaban

Answer 30

Start - 15mg BD - 7days Continue - 20mg OD

Question 31

What is the treatment dose in VTE for Apixaban

Answer 31

Start - 10mg BD - 7 days Continue - 5mg BD

Question 32

Provoking factors of VYE

Answer 32

• pregnancy • combined pill • surgery • bed bound

Question 33

In which condition should short term anticoagulation for primary VTE not be stoped

Answer 33

COVID-19

Question 34

Diagnosis VTE

Question 35

What wells score is DVT most likely and what steps would you take - diagnosis

Answer 35

Score 2 and over • within 4 hours - proximal vein ultrasound OR • d-dimer test, anticoagulant and ultrasound within 24 hours Positive scan - diagnose and continue anticoagulants Negative scan - do dimer • positive - d dimer - second scan • negative scan - stop anticoagulation

Question 36

What wells score is DVT less likely and what steps would you take

Answer 36

Score - one and under Do d dimer test within 4 hours OR Intermittent anticoagulation while awaiting regular Positive - follow if score was 2 and over Negative - stop intermittent therapy

Question 37

What wells score is PE most likely and what steps would you take - diagnosis

Answer 37

Score over 4 Immediate CT pulmonary angiography OR Anticoagulation whilst waiting Positive scan - diagnose Negative scan - suspect DVT

Question 38

What wells score is PE less likely and what steps would you take

Answer 38

Score 4 and under D dimer within 4 hours OR anticoagulants whilst awaiting results D-dimer Postive - continue as if score is over 4 D-dimer negative- stop therapy

Question 39

In general how long can prophylactic be extended for

Answer 39

7 dsys

Question 40

In general which LMWH is first choice

Answer 40

Fondaparinoux