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PVT

Perth Haematology :: Dr Steven Ward

Thrombosis

 

 

   
 

 

Thrombosis = Clot in a vein or artery

 

DVT = Deep Venous Thrombosis

 

PE = Pulmonary Embolism

 

Embolism (Embolus) = a clot which has dislodged and moved through the circulation to lodge in a new position - causing blockage of the vessel

 

Thrombosis increases with age and with certain risk factors.

There are two groups of risk factors:

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Physical Factors: Immobility, surgery (especially lower limb or abdomen), long flights, Pregnancy, the contraceptive pill (oestrogen), smoking, cancer

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Blood (circulating) risk factors: factors in the blood stream which lead to clotting.

 

Often a clot is related to a combination of factors occuring at once.

Sometimes no reason for a clot can be determined.

 

DVT

Symptoms:

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discomfort or pain in the affected area- usually leg, mostly calf, can be arm or neck or anywhere

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swelling

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heat

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tenderness

Diagnosis:

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Doppler Ultrasound: to confirm a thrombus within the vessel

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D-Dimer: a blood test which is elevated in significant thrombosis (but also in other conditions).

Treatment:

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anticoagulation - thinning the blood

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pressure stocking to reduce swelling and help prevent post-thombotic syndrome

 

PE

Symptoms:

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shortness of breath

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chest pain - often sharp and worse on breathing or coughing (pleuritic)

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haemoptysis - coughing up blood

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collapse

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sometimes features of a leg DVT are also present

Diagnosis:

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V/Q (ventilation/perfusion) lung scan to determine blockage to the circulation within the lung without any blockage to gas exchange OR

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CT PA a CT scan with iv contrast to delineate the pulmonary vessels - more commonly performed now

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D-dimer: raised in significant PE (but also in other disorders)

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Often further tests are performed to determine the source of the original clot (doppler USS, heart studies)

Treatment

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Anticoagulation