DVT

Question 1

Sequelae of DVT?

Answer 1

• PE

- Chronic venous insufficiency

Question 2

Aetiology of DVT?

Answer 2

Virchow’s Triad: endothelial activation (i.e. injury), hypercoaguability, stasis.

Question 3

How does stasis affected DVT risk?

Answer 3

Venous stasis due to immobilisation inhibits clearance and dilution of coagulation factors.

Question 4

What are the acquired contributors to hypercoaguability?

Answer 4

• Age
• Surgery
• Trauma
• Neoplasms
• Blood dyscrasias, hyper viscosity
• Hormonal (pregnancy, OCP)
• Heart failure

Question 5

CFx DVT?

Answer 5

• Unilateral leg oedema, erythema, warmth and tenderness
• Palpable cord (thrombosed vein)
• Phlegmasia -cerulea dolens/-alba dolens with massive thrombosis

Question 6

DDx DVT?

Answer 6

• MSK: strain/tear
• Vascular: lymphangitis/obstruction; venous valvular insufficiency; arterial occlusive disease
• Ruptured popliteal cysts
• Cellulitis

Question 7

What is the purpose of VTE treatment?

Answer 7

• Prevent clot extension
• Prevent PE
• Reduce risk of recurrence
• Treat acute lower limb ischaemia/ venous gangrene
• Limit late complications (e.g. chronic venous insufficiency, chronic thromboembolic pulmonary HTN).

Question 8

Initial Rx VTE?

Answer 8

-LMWH (requires renal dosing)

Question 9

Long term Rx VTE?

Answer 9

Warfarin (initiated with heparin overlap ==> dual for 5/52. Cease once INR >2.0 for 2/7).

Question 10

Duration of anticoagulant treatment?

Answer 10

• 1st DVT + transient RFx: 3 months
• 1st DVT + ongoing RFx: consider indefinite therapy
• 1st DVT + idiopathic: 6-12 months
• Recurrent DVT: indefinite

Question 11

Alternative to anti-coagulation in DVT?

Answer 11

IVC filter: only if distal acute DVT (