Summary: Hemostasis - Thrombotic Disorders

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• 1 Venous thromboembolism

• 1.1 Deep venous thrombosis

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• What are the symptoms of DVT?

  • Swelling/ pitting oedema
  • Redness
  • Pain (start with muscular pain)
  • Presence of collateral superficial veins
  • When venous pressure is higher than arterial pressure  no pulsations

• What are the diagnostic methods used to diagnose DVT?

  • Prediction model: Wells score 
    
  • D-dimer testing 
  • Additional diagnostic methods (compression echography, duplex, CT venography)

• What is the goal of D-dimer testing? And what is the sensitivity and specificity of the test?

  The goal is diminishing the number of diagnostics examinations.
  

  • Sensitivity: 84%
  • Specificity: 50% 

• How is a compression echography performed?

  It is a 2-point echography where the researcher looks at the a. poplitia and a. fermoralis. They look if the veins can be compressed. It is a quick and highly sensitive diagnostic method!

• How is a duplex echography performed?

  Imaging of the blood flow in the vein. When there is an DVT you see no flow during the ultrasound. It takes a longer time compared to the compression ultrasound and there are no differences in sensibility.

• When do you use a CT venography?

  When the thrombus is suspected in the iliaca or pelvic veins (high in the leg), CT venography is indicated because a compression echography is not possible at this location.

• What is the standard protocol for the diagnosis DVT?

  1. Wells score 
  2. < 2: D-dimer testing 
  3. > 500: compressive echography 

  
  
  

  1. Wells score 
  2. > 2: compressive echography

  
  
  When the compressive echography is normal, a ultrasounds needs to be maken 6 days later.

• What are the treatment options for a DVT?

  • DOAC: first choice 
  • Vitamin K antagonists
  • Subcutanous low-molecular-weight heparin: when the thrombosis is really large 
  • Unfractionated heparin: only used in really severe thrombosis
  • Thrombolysis: only used when
  • patient is hemodynamic instable
  • signs of shock or cyanose

• What is the duration of the treatment of thombosis when it is provoked or unprovoked?

  • Provoked: 3 months and factor that provoked it needs to be eliminated. A duplex echography is necessary 
    
  • Unprovoked: lifelong

• When the patient stops with anticoagulation (provoked thrombosis) then a duplex is indicated. Why is that?

  1. Risk of recurrent thrombosis 
     
  2. Status of damage: to explain why the symptoms come back. A big problem is postthrombotic syndrom.