I find this mneumonic extremly helpful, for the risk factors of VTE.
E - Ex VTE
M - Malignancy
B - Baby? - Pregnant?
O - Oestrogen - Patients on OCP or HRT?
L - Large - Obesity
I - Immune Diseases - Antiphospholipids? or Inborn Congenital Disease - Thrombophilia - protein C or S deficiency?
S - Surgery recently?
M - Mobilization
Lets talk about DVT.
Use Well's score to stratify the risk of having a DVT/PE, and most of the criteria in the scoring are within the mnemonic above. Plus the symptoms of DVT.
Local - Leg pain? Calf tenderness? Erythema? Swelling? Warmth?
Systemic - Fever, Rigors etc.
D-dimers - Rubbish. Also elevated in pregnancy, cancer, surgery, etc.
A positive D dimer with high Well's = diagnosis - treat as DVT plus do a US to confirm.
A negative test with a high Well's score means bring back the patient in a week's time to do US to catch DVT.
A negative test with low Well's score means adios patient.
A positive test with low Well's...i dunno.
Low Molecular Weight Heparin - Enoxaparin - 1.5mg/kg/24 hrs SC. and start warfarin immediately, aiming INR 2-3, for 3 months normally, and 6 months post surgery. Stop enoxaparin when u hit the therapeutic INR and after at least 2 days coz warfarin is prothrombotic in the first 2 days.
Vena Cava filters. Inferior Vena Cava.
Prevention better than cure.