study_ing
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- whats the gold stabndard?
- whats the STEP of choice in pt with P/e strongly suggetsive of DVT?
- what the test of choice in recurrent DVt
- whats the test of choice in a female on oc on initial prz?
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| study_ing
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th egold standard wud be venography right. now what about the rest?
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| chemamr
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1) venography would be the gold standard
2) when you suspect it, you can check the pre-test probability assessment (wells f.ex), and then if itīs low probab: d-dimer; mod-high probab: U/S.
3) impedance plethysmography, i think.
4) duplex U/S?
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| chemamr
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any other opinion?
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| study_ing
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1, 3 and 4 are correct.
in 2 the next step is to do a doppler US too.  ..this where we have to differentiate btw PE and DVT. in the DVT we have to confirm dx before proceeding with treatment. in PE, had we suspected it, we wud proceed with hepain without getting a v/q scan. clinical supicion of PE is enuff. for DVT we need to confirm the dx before we move on to treatment.
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| study_ing
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interesting avatar btw
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| chemamr
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P/E stands for Pulm embolism?, ok. i thought it was phys examination. Yes, you can do doppler US.
ok, good questions
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| docnikki
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good quest study_ing
when the treatment is on the same line for PE and DVT, why do we have to confirm or rule out DVt in a patient of PE before starting therapy. In my knowledge for both we give LMWH followed by warfarin and add thrombolytics if PE is massive.
afew more interesting quest.
1)what is test of choice for suspected iliac vein and IVC thrombosis?
2)What is test of choice to detect DVT in 2nd and 3rd trimester pregnant woman?
3)what is test of choice to detect calf vein thrombosis?
4) what next should we do if we get positive D-dimer assay and negative USG?
5) what next if a negative D-dimer and a negative USG?
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| chemamr
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1)what is test of choice for suspected iliac vein and IVC thrombosis? MRI
2)What is test of choice to detect DVT in 2nd and 3rd trimester pregnant woman? MRI
3)what is test of choice to detect calf vein thrombosis? MRI too?
4) what next should we do if we get positive D-dimer assay and negative USG? DVT is ruled out
in an unlikely patient; likely patient: repeat clinical evaluation and US in 1 wk.
5) what next if a negative D-dimer and a negative USG? in an unlikely pt, you rule out DVT.
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| study_ing
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"when the treatment is on the same line for PE and DVT, why do we have to confirm or rule out DVt in a patient of PE before starting therapy. In my knowledge for both we give LMWH followed by warfarin and add thrombolytics if PE is massive. "
in DVT the thrombosis is not tthe emergent problem. its the risk of PE.
in PE the life threatening complication has already occured.
remember anticoagulation carries its own risks too. hence in the case of PE, the risk of anticoagualtion is justified. in DVT it is not. confirming the dxing and then anticoagulating is a better option. in PE the delay might cost us a life.
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| docnikki
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thank you study_ing. I got your point that in PE the complication has already occurred and use of anticoagulants is a must and risks of aniticoagulation don't out weigh the complications that PE might lead to. My quest still remains..that in case of documented PE( the complication still occurred) do we still need to explore for a DVT..if yes then why so if we are still going to straight away prescribe anticoagulants even if DVT was found to be absent.
What I am thinking now is that maybe we don't explore for a DVT in an established diagnosis of PE..its only when we are unable to form a definite diagnosis of PE, we need to test for DVT which if positive confirms a PE even in a case of low clinical suspicion for PE coz of the high association of PE with DVT.
correct me if Im wrong. thanks
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| docnikki
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Chemamr, your answers are correct. good job!
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| chemamr
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i think in all pts with PE you should check for a likely DVT, at least clinically to start. The assoc is around 50-70% sometimes.
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| docnikki
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thanks chemamr.
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