Finals 4: VTE ( DVT and PE)

I find this mneumonic extremly helpful, for the risk factors of VTE.

EMBOLISM

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.

Investigations:

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.

Treatment?

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.