Term
|
Definition
>60yrs
-Malignancy
-Hx DVT, PE, Varicose Veins
-Hypercoaguable (Factor V Leiden, Protein C and S deficient, Antithrombin III deficient)
-Bed rest /immobilized
-CHF or other cardiac Dz
- Obesity
-Major Sx
-Trauma
-Pregnancy, estrogen use |
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Term
|
Definition
-Endothelial Injury
-Venous stasis
-Hypercoaguability
Gives rise to venous thrombosis |
|
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Term
|
Definition
-low sensitivity and specificity
-LE pain and swelling, worse w/ dependency/ walking
-Homans' sign - calf pain w. dorsiflexion
-Palpable cord
-fever |
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Term
|
Definition
-Doppler and Duplex U/S-non-invasive, good initial test
-Venography-most accurate but invasive so infrequently used
-Impedence plethysmography- noninvasive, distinguishes electrical conductance of tissue and blood, good proximal, false positives distal
-D-Dimer |
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|
Term
|
Definition
High sensitivity but low specificity, marker of thrombus breakdown
-Used to rule out DVT
-Combined w/ doppler and clinical suspision |
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|
Term
| Intermediate to High risk DVT |
|
Definition
-Doppler US positive
-Begin anticoagulant |
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|
Term
| Low to intermediate risk DVT |
|
Definition
Doppler US negative
-repeat in 2 days and observe |
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Term
|
Definition
-PE
-Postthrombotic Syndrome (chronic venous insufficiency)
-Plegmasia cerulea dolens- severe leg edema |
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|
Term
|
Definition
1. Anticoagulants- prevents propagation of thrombus
Heparin Bolus w/ infusion PTT 1.5-2
Warfarin for 3-6months, INR 2-3
2. Thrombolytics- pts w/ massive PE, hemodynamically unstable, right heart failure, speeds up resolution of clot |
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Term
|
Definition
-Prophylactive IVC filter placement - Greenfield filter, high risk PE
-Mechanical - elevation, compression hose, ambulation, pneumatic compression boots
-Pharm - LMWH post-op until ambulatory |
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|
Term
|
Definition
-Supplemental O2
-LMWH or unfractionated Heparin
-Warfarin long term
-Thrombolytics- if massive or hemodynamically unstable
-IVC filter |
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Term
|
Definition
-Pulmonary angiography *gold standard*-invasive w/ contrast
-D-dimer- if normal and clinical suspicion low, Rule out
-Spiral CT- w/ IV contrast
-V/Q scan- traditionally used
-CXR- often normal |
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