VTE + anticoagulation Flashcards
(52 cards)
What is a distal DVT
Popliteal vein - behind knee or below
What is a proximal DVT
Above the popliteal
Sites of a PE
Central #Segmental
Sub segmental
COmplications of PE
Post thrombotic syndrome
Pulmonary HPTN -> cor pulmonale
Psychological - stress, anxiety et c
Risk factors PE
Cancer
Pregnancy + 6 weeks PP
Surgery - over 30 mins
Fracture, esp if immobile/cast
Flight >4 hours
Recent hospitalisation
Hormone therapy - COCP, HRT
Immobility>3 dyas
How to rule out DVT
Low wWells score + negative D dimer
What is the problem with D dimer
High prevalence groups may have negative D dimer and PE
When is active phase
4 weeks after initial
Treatment prevents -> PE or extension of clot
Contraindication for DOACs
Impaired renal function, extreme weights, elderly
What are LMWH particuarly good for
Stopping and starting - immediate effet
eg tinzaparin
What drug do you use for a goal INR of 3-4
Warfarin
What anticoag use in severe renalimpairment
Warfarin
What drug more likely cause ICH and is reversible
Warfarin
What are clots like in heparin induced thrombocytopenia?
Platelet rich white clot (more common arterial disease)
Do you treat sub segmental PE
If symptomatic yes #If not detabatable
What is budd chiari syndrome
Thrombosis of hepatic veins which drain liver -> culminant hepatitis liver failure
What is portal vein thrombosis
Clot in portal veins, bring blood from GI tract into liver - 1/3 of hepatic nutrients/O2
What causes upper limb clots
In the upper extremity, 40-80% of clots are related to central venous catheters, and 4% are related to anatomic thoracic outlet obstruction/tight space between subclavian and 1st rib.
Massive eg illiofemoral DVT presentation
phlegmasia cerulea dolens (venous gangrene, cyanosis, arterial compromise).
What is pleuritic chest pain
i.e. sharp, localized, worse when taking a deep breath, persistent;
Why repeat US in one week for DVT
Check for signs of extension/embolisation as often within one week
Wells categories DVT
1 bedridden > 3day or major surgery past 4 weeks
1 cast/immobilization lower extremity
1 active cancer or cancer treatment past 6 months
1 swelling of entire leg
1 collateral veins
1 tenderness along deep veins
1 pitting oedema greater in symptomatic leg
1 calf swelling >3 cm diameter at 10 cm below tibial tuberosity
-2 alternative diagnosis more likely than DVT
Management dependent on Wells
-2-0 = low probability
1-2 = moderate probability
>2 = high probability
low or moderate probability: if D-dimer negative, DVT excluded; if D-dimer +, proceed to
compression U/S
high probability: Proceed to U/S. If U/S negative or inconclusive, repeat in 1 week or
consider MRV/venography.
Wells categories for PE
3.0 – signs/symptoms of DVT
3.0 – alternative diagnosis less likely (to me, practically this often means hypoxaemia
with a clear CXR)
1.5 – previous DVT/PE
1.5 – tachycardia
1.5 – immobilization/plaster cast/surgery past four weeks
1.0 – haemoptysis
1.0 – active malignancy
