Clots

Question 1

What to give if suspect PE

Answer 1

Apixaban or rivaroxaban

If the patient has active ca -> DOAC also (this used to be LMWH)

Question 2

What to give if suspect PE but:
1) Renal impairment
2) Anti Phospholipid syndrome

Answer 2

if severe renal impairment then LMWH, unfractionated heparin or LMWH then warfarin

Triple +ve APS: LMWH followed by a VKA(warfarin)

Question 3

How long to anticoagulant suspected PE

Answer 3

At least 3 months.

If provoked then 3 months (6 if active ca)

Unprovoked 6 months

Question 4

When might you use an IVC filter?

Answer 4

Patients who have repeat PEs despite anticoagulation.

Question 5

How to manage a ischaemic stroke if presented within 4.5 h

Answer 5

A combination of thrombolysis AND thrombectomy

Question 6

What to do if a DVT is suspected in a pregnant woman or 6w post partum

Answer 6

refer to be seen same day. Don’t need to do wells necessarily

Question 7

What to do if WELLS score for DVT 2 or more

Answer 7

can use be done in 4h?
If not anticoagulant and USS within 24h.

Question 8

What to do if WELLS score for DVT is 1 point or less

Answer 8

D-dimer - need result in 4h. If cant get this then anticoagulate whilst waiting for result.

If D-dimer is positive, USS within 4h. If cant get this then continue anticoagulant and USS within 24h.

If D dimer -ve stop anticoagulant

Question 9

What to do if d-dimer positive but USS negative

Answer 9

STOP anticoagulant and repeat USS in 1 week

Question 10

When would you test for antiphospholipid syndrome in the context of DVT

Answer 10

If they’ve had one and its unprovoked

Question 11

When would you do thrombophillia screening in the context of DVT

Answer 11

in people who have had unprovoked DVT and who have a first-degree relative who has had DVT or pulmonary embolism (PE).