DVT

Question 1

What is a DVT? (2 things)

Answer 1

1. Formation of thrombus (blood clot) in a deep vein
2. Partially / completely blocks blood flow

Question 2

What percentage of surgical patients do DVT occur in?

Answer 2

25-50%

Question 3

Who should be assessed for DVT / PE risk and be offered prophylaxis if needed?

Answer 3

ALL HOSPITAL PATIENTS

Question 4

What are the Risk Factors for DVT? (10 things)

Answer 4

1. Age
2. Pregnancy
3. COCP / Hormone Therapy
4. Obesity
5. Immobility (Long flights / casts)
6. Surgery (esp pelvic / orthopaedic)
7. Trauma
8. DVT Hx
9. Cancer
10. Thrombophilia

Make sure u ask ones in bold in OSCE

Question 5

Why are Venous clots (DVT) easier to form than Arterial clots?

Answer 5

Arterial clots need damage to walls to form clots

Venous clots don’t

Question 6

What is the Pathophysiology of a DVT? (3 things)

Answer 6

Virchow’s Triad

1. Hypercoagulability: Increased Clotting Factor Synth + Increased Platelet adhesion –> Clot
2. Endothelial Damage: inflamm / trauma –> Tissue factor exposure –> (Prothombin–>Thrombin) –> (Fibrinogen–>Fibrin) –> Clot
3. Stasis: Immobilisation / Venous valve incompetence –> Blood stasis –> Clot

Question 7

What are the factors that lead to the Hypercoagulability part of Virchow’s Triad? (7 things)

Answer 7

Hereditary causes:

1. Antiphospholipid syndrome (causes recurrent miscarriages)
2. Factor V Leiden
3. Anti-thrombin 3 deficiency
4. Protein C/S deficiency

Acquired causes:

1. Cancer
2. COCP / Hormone Replacement Therapy
3. Pregnancy

A FAP COP

So if you see a patient w recurrent miscarriages, she probs has Antiphospholipid syndrome n is @ risk of DVT

Question 8

What are the factors that lead to the Endothelial Damage part of Virchow’s Triad? (4 things)

Answer 8

1. HTN
2. Cigarette smoking
3. Trauma
4. Central Venous Access

Question 9

What are the factors that lead to the Stasis part of Virchow’s Triad? (4 things)

Answer 9

Immobilisation (long flights / casts)

Question 10

What are the CF of DVT? (7 things)

Answer 10

1. 50% asymptomatic (bc venous collateral channels)
2. Unilateral leg pain + swelling
3. Calf warmth / tenderness / swelling (entire leg if extensive)
4. Red
5. Visible superficial veins (bc high venous pressure) (17%)
6. Mild fever
7. Pitting oedema

Question 11

What investigations should you do for sus DVT? (3 things)

Answer 11

1. Well’s Score
2. D-DIMER
3. Doppler US

In that order

Question 12

What does the Well’s Score tell you in sus DVT?

Answer 12

The likeliness of a DVT

2+ score = DVT likely

Question 13

What does the Well’s Score include? (4 things)

Answer 13

1. Recent surgery
2. Calf swelling over 3cm (compared to other leg)
3. Cancer
4. Pitting oedema

1 point each

Ders more but jus remember dese 4

Question 14

What should you do if the Well’s Score is 2+, aka DVT = likely?

Answer 14

Do a D-DIMER

Question 15

If your Well’s Score is 2+, but your D-DIMER is NIGGATIVE, what dis mean?

Answer 15

No DVT, go home nigga

Question 16

If your Well’s Score is 2+, and your D-DIMER is POSITIVE, what dis mean?

Answer 16

Maybe a DVT –> Do a US to confirm

(only “maybe” bc other tings can raise D-DIMER too)

Question 17

What other tings can cause a raised D-DIMER? (5 things)

Answer 17

1. Pneumonia
2. Cancer
3. HF
4. Surgery
5. Pregnancy

Question 18

If your Well’s Score is 2+, D-Dimer is positive, and US is NEGATIVE, what should you do?

Answer 18

Repeat US in 6-8 days

Bc ma mmkin Wells AND D-Dimer both positive n no DVT,wt u playing at

Question 19

What might you see in a US in DVT? (3 things)

Answer 19

1. Increased / Decreased vein diameter*
2. Absent colour flow (= completely blocked)
3. Increased flow in surrounding superficial veins

*(Increased = Acute DVT / Decreased = Chronic DVT)

Question 20

What are the FIRST LINE management options for DVT?

Answer 20

DOACs (Apixaban / Rivaroxaban)

Question 21

What are the SECOND LINE management options for DVT? (2 things)

Answer 21

LMWH (Low Molecular Weight Heparin)

with

Dabigatran / Edoxaban (DOACs) OR Warfarin (Vit K antagonist)

Question 22

What is the FIRST LINE treatment for DVT but has severe Renal impairment / Antiphospholipid syndrome?

Answer 22

LMWH / Unfractionated Heparin

(DOACs not safe in Renal Impairment bc meant to be cleared by Kidney)

Question 23

What is the FIRST LINE treatment of DVT in Pregnancy / Breastfeeding?

Answer 23

LMWH

DOACs not safe in pregnancy / breastfeeding

Question 24

How long should DVT patients take their Anticoagulation meds for?

Answer 24

At least 3 months

Question 25

After 3 months of anticoagulation meds, what determines if a DVT pt should carry on / stops meds?

Answer 25

If DVT was provoked by an acc event (e.g immobilisation after surgery) (can stop) or if they jus have acc risk factors (carry on taking for 3 more months)

Question 26

After 6 month course of anticoagulation meds (bc DVT was unprovoked), what should you do for a DVT pt who will now stop taking meds? (2 things)

Answer 26

Test them for: 1. Antiphospholipid syndrome (check for antibodies) 2. Hereditary thrombophilias (only if have 1st Degree FHx of DVT / PE)

Question 27

What are the complications of DVTs? (2 things)

Answer 27

1. Pulmonary Embolism 2. Post-thrombotic syndrome (50%)