VTE, Thrombosis and Malignancy

Question 1

Describe the symptoms and signs of VTE

Answer 1

DVT: (mostly unilateral) swollen, warm and red leg, painful. Pitting oedema, tenderness, pyrexia, tachycardia and muscle induration possible signs.
PE:

Question 2

Outline the diagnosis of DVT

Answer 2

Likelihood of DVT assessed using Wells’ Score: active cancer, immobilisation, major surgery, localised tenderness, swollen leg, calf swelling, pitting oedema, collateral superficial veins (non-varicose), previous DVT.

• When DVT is likely, collect blood and assess D-dimer levels; if low, request ultrasound scan.
• When DVT is unlikely, offer D-dimer test. If low or negative follow up with ?conservative management. If D-dimer +ve, perform USS.

Question 3

Causes of raised D-dimer

Answer 3

D-dimer tests are not specific and have low positive predictive value for thrombosis. It has a high negative predictive value.
D-dimer are part of fibrin-degradation products (FDP) so levels are raised when there is thrombosis and fibrinolysis.
Other causes of raised levels include: old age, recent surgery

Question 4

Investigations in PE

Answer 4

If PE likely, offer immediate CTPA. If CTPA unavailable, offer interim parenteral anticoagulant therapy.
If PE unlikely, offer D-dimer and if +ve, offer CTPA.