Deep vein thrombosis classification scheme
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D.  ;Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
Deep vein thrombosis Microchapters
Deep vein thrombosis classification scheme On the Web
Deep vein thrombosis (DVT) is classified based on the site of occlusion or clot formation. Symptom presentation and complication is largely influenced by location of the embolus.
Classification Based on Site of Thrombus Formation
- Upper extremity deep vein thrombosis (DVT): DVT of the upper limbs.
- Lower extremity DVT: DVT of the lower limbs, which is subdivided into two categories:
- Proximal vein thrombosis: Occur in the legs, and involve the popliteal, femoral or iliac veins
- Distal (calf) vein thrombosis: Confined to the deep calf veins
In studies including inpatients, 80% of DVTs are proximal and distal DVT accounts for only 20% of all DVTs,    while studies with outpatients report a proportion of distal DVT as high as 60–70%. 
Proximal Vein Thrombosis
Proximal vein thrombosis involves the proximal veins, including the popliteal, femoral, or iliac vein. Proximal vein thrombosis is responsible for more than 90% of acute pulmonary emboli and is associated with higher mortality.  Clinically, proximal vein thrombosis is considered severe, as it is more commonly associated with serious, chronic diseases, such as:
Distal Vein Thrombosis
Distal or calf deep vein thrombosis involves infrapopliteal veins [ie, posterior tibial veins, peroneal veins, anterior tibial veins and muscular calf veins (soleal or gemellar veins)]. It is often associated with transient risk factors, such as:
- Recent surgery.
- Calf Vein Thrombosis
- It causes 50% of DVTs.
- High risk of embolization.
- Recurrence rate is low compared to proximal DVTs.
- ACCP Guidelines for Calf Vein Thrombosis -
- If symptoms are not severe with no risk factors, repeat ultrasound can be done weekly. (Grade 2C recommendation)
- If symptoms are severe, then treatment is required.(Grade 2C recommendation)
- If there is propagation of a thrombus, treatment is required. (Grade 1B recommendation)
- Duration treatment is low, 3 months.
Upper Extremity DVT
- It is most likely due to:
- Risk of embolizing to PE is less. (10%)
- Risk of fatality is very low (1%).
- Catheter directed thrombolytic therapy.
- Anticoagulants for a period of 3 months.
Classification Based on Depth of Thrombus Formation
- Superficial Versus Deep
- A palpable thrombus formation is classified as a superficial venous thrombus. Clots forming in the lower leg and thigh vasculature (lesser and greater saphenous veins, respectively) or the forearm and upper arm vasculature (radial, ulnar, cephalic and basilic vein, respectively) are also superficial.
- Thrombus formation in the brachiocephalic veins, the internal jugular and the superior vena cava are classified as deep.
Classification Based on Clinical Presentation
Subacute versus acute:
- Subacute thrombosis refers to thrombosis formation involving a narrowing of the vein involved and a hyperechogenic clot; flow may be partially obstructed by this narrowing.
- Acute thrombosis can refer to:
- A vein with a thrombus that is normal or, even, wider than usual with the contralateral side of the vein being unaffected.
- A clot that, during ultrasound echos, is not dense.
- A clot that may totally or partially obstruct blood flow.
- In the evaluation of the upper extremity, the subclavian and brachiocephalic veins inability to be compressed may pose challenges for determining subacute versus acute status.
- ↑ Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS (April 1998). "Does this patient have deep vein thrombosis?". JAMA 279 (14): 1094–9. PMID 9546569.
- ↑ Wells PS, Hirsh J, Anderson DR, et al. (May 1995). "Accuracy of clinical assessment of deep-vein thrombosis". Lancet 345 (8961): 1326–30. PMID 7752753.
- ↑ Cogo A, Lensing AW, Prandoni P, Hirsh J (December 1993). "Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound". Arch. Intern. Med. 153 (24): 2777–80. PMID 8257253.
- ↑ Bressollette L, Nonent M, Oger E, et al. (August 2001). "Diagnostic accuracy of compression ultrasonography for the detection of asymptomatic deep venous thrombosis in medical patients--the TADEUS project". Thromb. Haemost. 86 (2): 529–33. PMID 11521998.
- ↑ Oger E (May 2000). "Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale". Thromb. Haemost. 83 (5): 657–60. PMID 10823257.
- ↑ 6.0 6.1 6.2 Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, Boge G, van Kien AK, Gattolliat O, Bettarel-Binon C, Gris JC, Genty C, Quere I (September 2009). "Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study". Thromb. Haemost. 102 (3): 493–500. doi:10.1160/TH09-01-0053. PMID 19718469. Retrieved on 2011-12-14.
- ↑ Joffe HV, Kucher N, Tapson VF, Goldhaber SZ (September 2004). "Upper-extremity deep vein thrombosis: a prospective registry of 592 patients". Circulation 110 (12): 1605–11. doi:10.1161/01.CIR.0000142289.94369.D7. PMID 15353493. Retrieved on 2012-10-07.
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