Deep vein thrombosis resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
Deep vein thrombosis (also known as deep venous thrombosis or DVT and colloquially referred to as economy class syndrome) is the formation of a blood clot ("thrombus") in a deep vein. The risk is significantly increased if the thrombus embolizes to the lungs, causing pulmonary embolism.
Causes
Life Threatening Causes
Common Causes
- Long term immobility
- Clotting disorders
- Cardiac failure
- Hip replacement
- Estrogen in OCP and HRT
- Nephrotic syndrome
- Obesity
- Pregnancy
Diagnostic approach[1]
| Pretest Probability of DVT Major points 1-Active cancer 2-Paralysis,paresis or plastic immobilization of leg or foot 3-Recent bed rest >3 days or major surgery in the last 4 weeks or both 4-Calf or thigh swelling 5->3 cm calf swelling below the tibial tuberosity 5-Strong F/H of DVT Minor points 1-H/O recent trauma to the suspected leg 2-Pitting edema in the suspected leg 3-Dilated superficial veins in the suspected leg 4-Hospitalization in the last 6 months 5-Erythema | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Low probability* | Moderate probability* | High probability* | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| D-Dimer | D-Dimer | U/S | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Negative | Positive | Negative | Positive | Negative | Positive | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No DVT | U/S | No DVT | U/S | Repeat in 7 days | D-Dimer | Treat | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Negative | Positive | Negative | Positive | Negative | Positive | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No DVT | Treat | Repeat in 7 days | Treat | No DVT | Repeat in 7 days | U/S | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
High probability:
>3 major points+ no alternative diagnosis
or 2 major points + 2 minor points + no alternative diagnosis.
Low probability:
1 major point +≥2 minor + alternative diagnosis
or 1 major + ≥1 minor + no alternative diagnosis
or no major points+ irrespective of minor points +irrespective of diagnosis.
Moderate probability: neither high or low probability.[2]
Management
Do's and Don'ts
References
- ↑ Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD; et al. (2012). "Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e351S–418S. doi:10.1378/chest.11-2299. PMC 3278048. PMID 22315267.
- ↑ Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L; et al. (1997). "Value of assessment of pretest probability of deep-vein thrombosis in clinical management". Lancet. 350 (9094): 1795–8. doi:10.1016/S0140-6736(97)08140-3. PMID 9428249.