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Surgery LO's > DVT > Flashcards

DVT Flashcards

1
Q

What % of surgical patients do DVTs occur in?

A

25-50%

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2
Q

What is Virchow’s Triad?

A

Blood contents
Blood flow
Vessel wall

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3
Q

What are the ‘blood contents’ risk factors for DVT post-operatively?

A

Surgery causes an increase in platelets and fibrinogen
Dehydration
Malignancy
Increasing age

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4
Q

What are the ‘blood flow’ risk factors for DVT post-operatively?

A

Surgery
Immobility
Obesity

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5
Q

What are the ‘vessel wall’ risk factors for DVT post-operatively?

A

Damage to veins, especially pelvic veins

Previous VTE

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6
Q

When does post-operative DVT have its peak incidence?

A

5-10 days post-op

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7
Q

What % of below knee DVTs are asymptomatic?

A

65%

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8
Q

What are the symptoms of DVT?

A

Calf warmth, tenderness, erythema, and swelling
Mild pyrexia
Pitting oedema

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9
Q

What are the differential diagnoses for DVT?

A

Cellulitis

Ruptured Baker’s cyst

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10
Q

How are DVTs investigated post-operatively?

A

Compression US

Thrombophilia screen?

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11
Q

What is found on compression US in DVT?

A

Clot will be incompressible

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12
Q

When is a thrombophilia screen required in post-operative DVT?

A

If no precipitating factors, recurrent DVT, or family Hx

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13
Q

How is decided how to investigate a suspected post-op DVT?

A

Assess probability using Wells’ Score

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14
Q

How is suspected post-op DVT investigated if it was a low-probability on Wells’ score?

A

Perform D-Dimers - if negative excludes DVT, if positive do compression US

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15
Q

How is suspected post-op DVT investigated if med/high probability on Wells’ score?

A

Compression US

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16
Q

How is post-op DVT managed?

A

Anti-coagulation

Graduated compression stocking

17
Q

How is a patient with DVT anti-coagulated?

A

Therapeutic LMWH

Start warfarin using Tait model

18
Q

What is given in therapeutic LMWH?

A

Enoxaparin 1.5mg/kg/24hour SC

19
Q

What is the Tait model of warfarin?

A

Give 5mg OD for first 4d

20
Q

How long should LMWH be given in DVT?

A

Until INR 2.5

21
Q

How long should warfarin be given in a patient with a below knee DVT?

A

6-12 weeks

22
Q

How long should warfarin be given in a patient with an above knee DVT?

A

3-6 months

23
Q

How long warfarin be given in a patient with an ongoing cause for DVT?

A

Indefinite

24
Q

When should graduated compression stockings be considered in post-op DVT?

A

For prevention of post-phlebitic syndrome

25
Q

How is DVT prevented pre-operatively?

A

Pre-op VTE risk assessment
TED stockings
Aggressive optimisation, especially hydration
Stop OCP 4 weeks pre-op

26
Q

How is DVT prevented intra-operatively?

A

Minimise length of surgery
Use minimal access surgery where possible
Intermittent pneumatic compression boots

27
Q

How is DVT prevented post-operatively?

A 
LMWH
Early mobilisation 
Good analgesia 
Physio 
Adequate hydration

Surgery LO's (10 decks)

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