DVT in afya

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?DVT - ''two-level DVT Wells score'' via MDCalc
2+ - likely DVT -  proximal leg vein USS within 4 hours - if negative do D-dimer which if positive, repeat USS at 7/7
1 - do D-dimer and if positive - proximal leg vein USS within 4 hours 
if USS >4hrs start LMWH and do within 24 hrs

''Management''
LMWH start as soon as DVT diagnosed
start warfarin within 24 hours of diagnosis
continue LMWH for 5 days or until INR is >2.0 for >24 hours
continue warfarin for 3 months and then  'assess risks and benefits of extending treatment'
extend warfarin to 6/12 if  unprovoked proximal DVT (else 3/12)
if active cancer use LMWH for 6/12

''Further investigations and thrombophilia screening'' - look for malignancy and thrombophilia
Offer all those with unprovoked DVT / PE
    physical examination
    chest X-ray 
    blood tests (FBC Ca LFT), urinalysis.
    Consider CTAP and mammogram  if over 40 years
Thrombophilia screening
    not if patients will be on lifelong warfarin (i.e. won't alter management)
    consider testing for antiphospholipid antibodies if unprovoked DVT or PE
    consider testing for hereditary thrombophilia in patients who have had unprovoked DVT or PE and who have a first-degree relative who has had DVT or PE

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