VTE, PE And DVT

Question 1

DVT signs

Answer 1

Leg:
- warmth
- redness
- engorges/swelling veins
- pain
- tenderness

Question 2

Why do legs swell in DVT

Answer 2

Venous thrombus in leg causes flow to be hindered
= increased resistance and hydrostatic pressure
= water forced out of the blood
= leg oedema

Question 3

What increases risk of VTE

Answer 3

Changes to vessel wall:
- vasculitis
- chemotherapy

Immobility (changes in flow):
- long haul flight
- hospital stays
- surgery

Changes to blood constituents:
- oral contraceptive pill
- cancer
- factor V linden
- pregnancy

Question 4

What route would an embolism take from the legs to the lungs:

Answer 4

• leg deep vein
• common iliac vein
• inferior vena cava
• right atrium
• right ventricle
• pulmonary artery lungs

Question 5

Why can you become breathless upon getting a VTE and why can blood oxygen levels be low?

Answer 5

VQ mismatch
- flow (Q) is limited whereas ventilation remains unchanged
- this can cause hypoxaemia
- lead to breathlessness feeling

Question 6

What risk scores are used to assess likelihoods of VTEs

Answer 6

The WELLs Score:
- combination of RISK FACTORS
- signs / symptoms common with DVT

Question 7

Investigations for VTE

Answer 7

• DDimer
• VQ scanning
• Computed Temography Pulmonary angiogram
• Leg Doppler ultrasound to visualise the venous clot (gold standard)

Question 8

What does the DDimer test show

Answer 8

• DDimer presence in the blood which is a breakdown of fibrin clot
• very sensitive
• but unspecific DDimer can be present for many many reasons

Question 9

Treatments for VTE - drugs

Answer 9

Anticoagulants:
- first line = Low weight molecular heparin
- later = put on DOACs - doacs inhibit 10a and 2a
- not used much: WARFARIN: not used anymore

Question 10

What factors does warfarin inhibit?

Answer 10

Potassium dependant factors:
- 2
- 7
- 9
- 10

Not used as much any more - only in in thrombophilia
As always need to check International Normalised ratio - old fashioned

Question 11

What happens if there is a big life threatening lung embolus - what drugs are you given:

Answer 11

If causing lowered blood pressure =
need THROMBOLYSIS
- synthetic tissue plasminogen activator needed

Question 12

Give examples of DOACs, what DOAC stands for and which factors they inhibit, and risks

Answer 12

Direct Oral Anti Coagulant
10a and 2a
Increased bleeding risk
Rivaroxiban, Apixaban, Edoxaban - all inhibit 10a
Dabigatran - thrombin - factor 2a

Question 13

What does low weight molecular heparin

Answer 13

Injected as first line of treatment for VTE
Inhibits factor 2a and 10a
Break down clots

Question 14

What other lifestyle changes can be reccomended for reducing risks of VTE

Answer 14

• smoking cessation
• lose weight
• become more mobile
• stay hydrated