DVT diagnosis
Proximal leg vein USS within 4 hrs OR
D-dimer and if positive USS within 24 hrs
D-dimer: what is it?
A fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis.
DVT Wells score (9+1)
- Active cancer
- Immobilization
- Bed-bound for 3+ dayes or major surgery w/in 12 wks
- Localised tenderness
- Entire leg swollen
- Calf swelling 3cm +
- Pitting oedema u/l
- Collateral superficial veins
- Previous DVT
- Alternative diagnosis is as likely as DVT (-2)
DVT Wells score outcomes
DVT likely if 2 +
DVT unlikely if less than 2
PE diagnosis (Wells score: PE likely)
CTPA (Pulmonary Angiogram) immediately OR
Parenteral anticoagulantion if CTPA not available immediately
PE diagnosis (Wells score: PE unlikely)
D-dimer
if positive -> CTPA
Contraindications for CTPA
Contrast allergy
Renal impariment
PE diagnosis (gold standard diagnosis is contraindicated)
V/Q SPECT scan or V/Q planar scan
PE Wells score (2+3+2)
3 points:
- Clinical features of DVT
- Alternative diagnosis is less likely
- 5 points:
- HR > 100
- Immobilization 3d+ or major surgery in the last 4 wks
- Previous DVT or PE
1 point:
- Haemoptysis
- Malignancy
PE Wells score outcomes
PE likely if more than 4
PE unlikely if 4 or less
Initial DVT/PE treatment (if confirmed)
LMWH or fondaparinux
UFH if increased risk of bleeding or PE with haemodynamic instability
(5 days or once INR >2)
Vitamin K antagonist if diagnosis within 24 hours
(3 months minimum)
Thrombolytic therapy for DVT is recommended for pt who have:
symptoms for <14 d AND
good renal function
life expecgancy >1 year
low bleeding risk
Thrombolytic therapy for PE is recommended pt who are
haemodynamically unstable
DVT/PE treatment if anticoagulation is contraindicated or unsuccessful
inferior vena cava filters
VTE prohylaxis
Deltaparin 5000 units s/c
