General Medicine
DVT and Pulmonary Embolism
Deep vein thrombosis and pulmonary embolism for MBBS: the Virchow triad, Wells score, D-dimer, imaging of choice and anticoagulation.
MedNext Academy | 3 min read
DVT and Pulmonary Embolism
Deep vein thrombosis and pulmonary embolism for MBBS: the Virchow triad, Wells score, D-dimer, imaging of choice and anticoagulation.
This supplementary chapter covers venous thromboembolism, linking deep vein thrombosis and pulmonary embolism through the Virchow triad. It sets out the use of clinical probability scores and D-dimer, the imaging of choice for each condition, and the principles of anticoagulation and thrombolysis.
High-yield: DVT and Pulmonary Embolism
- Venous thromboembolism includes deep vein thrombosis and pulmonary embolism, which lie on a single disease spectrum.
- Virchow triad of stasis, endothelial injury and hypercoagulability underlies venous thrombosis.
- Deep vein thrombosis presents with unilateral limb swelling, pain and tenderness.
- Pulmonary embolism classically presents with acute breathlessness, pleuritic chest pain and tachycardia.
- The Wells score estimates the pretest probability of deep vein thrombosis or pulmonary embolism.
- A D-dimer is useful to exclude venous thromboembolism in low-probability patients because of its high negative predictive value.
- Compression ultrasonography is the first-line imaging test for suspected deep vein thrombosis.
- Computed tomography pulmonary angiography is the investigation of choice for pulmonary embolism.
- The classic electrocardiogram finding of an S1Q3T3 pattern in pulmonary embolism is uncommon, and sinus tachycardia is more typical.
- Anticoagulation is the mainstay of treatment for both deep vein thrombosis and pulmonary embolism.
- Direct oral anticoagulants are now widely used as first-line therapy for most venous thromboembolism.
- Massive pulmonary embolism with haemodynamic instability may require thrombolysis.
- The duration of anticoagulation depends on whether the event was provoked or unprovoked.
- Thromboprophylaxis reduces venous thromboembolism in immobilised and postoperative patients.
- An unprovoked venous thromboembolism may warrant evaluation for an underlying cause.
Venous thromboembolism essentials
- **Spectrum:** Deep vein thrombosis and pulmonary embolism from the Virchow triad.
- **Probability and D-dimer:** Wells score guides testing; a normal D-dimer excludes disease in low-probability cases.
- **Imaging:** Compression ultrasonography for deep vein thrombosis; computed tomography pulmonary angiography for embolism.
- **Treatment:** Anticoagulation, often with a direct oral anticoagulant; thrombolysis for massive embolism.
Frequently Asked Questions
What is the investigation of choice for pulmonary embolism?
Computed tomography pulmonary angiography is the investigation of choice for confirming pulmonary embolism, while compression ultrasonography is first-line for deep vein thrombosis.
How is the D-dimer used?
A normal D-dimer has a high negative predictive value and is used to exclude venous thromboembolism in patients with a low clinical probability, avoiding unnecessary imaging.
When is thrombolysis used in pulmonary embolism?
Thrombolysis is reserved for massive pulmonary embolism with haemodynamic instability, whereas most patients are treated with anticoagulation alone.
How does this chapter help for NEET-PG?
The Wells score, D-dimer use, imaging choices and anticoagulation are common exam themes in general and emergency medicine.
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