VTE
= Venous thromboembolism
heritable risk factors
- Factor V Leiden - most common
- close family with spontaneous DVT
deep vein thrombosis
| DVT our old friend | Headline |
|---|---|
| Etiology | Virchow's triad! |
| Epidemiology | Risk factors: active cancer, immobility, recent surgery or hospitalisation |
| Clinical presentation | See 2-level Wells score |
| Pathogenesis | |
| Diagnostic investigations | - D-dimer - see below - Proximal leg USS Ddx: Baker's cyst, cellulitis, compressive mass |
| Immediate management | Immediate referral if pregnant 1st line anticoag: Apixaban/rivaroxaban - usually for 3/12 |
| Discharge advice and ongoing management | Unprovoked DVT: - Thrombophilia screen - Screening for cancer → bloods including coag screen |
use of wells score
Wells score >= 2 points = "DVT likely"
copied shamelessly from NICE guidelines
Offer people with a likely DVT Wells score (2 points or more):
- a proximal leg vein ultrasound scan, with the result available within 4 hours if possible (if the scan result cannot be obtained within 4 hours follow recommendation 1.1.4)
- a D‑dimer test if the scan result is negative. [2012]
If a proximal leg vein ultrasound scan result cannot be obtained within 4 hours, offer people with a DVT Wells score of 2 points or more:
- a D‑dimer test, then
- interim therapeutic anticoagulation (see the section on interim therapeutic anticoagulation for suspected DVT or PE) and
- a proximal leg vein ultrasound scan with the result available within 24 hours. [2012, amended 2020]
Wells score <= 1 = "DVT unlikely"
- Offer D-dimer
- If D-dimer positive, then DVT USS within 4h, else interim anticoagulation and arrange USS
- If D-dimer negative, stop anticoagulation and look for alternative diagnosis