U01.16.027 Deep Venous Thrombosis (DVT)

Deep venous thrombosis (DVT) refers to the formation of a blood clot within a deep vein, most commonly in the lower extremities. DVT can lead to complications such as pulmonary embolism, making early detection and treatment crucial.

Clinical Presentation

Symptoms: Swelling, redness, warmth, and pain in the affected area.
Physical Examination: Tenderness over the involved vein, possible palpable cord, and a positive Homan’s sign (pain in the calf on dorsiflexion of the foot).

Predisposing Factors: Virchow’s Triad DVT is often precipitated by the conditions outlined in Virchow’s Triad, which include:

Stasis: Occurs in situations such as post-operative periods, and prolonged immobility (e.g., long drives or flights).
Hypercoagulability: This can be due to inherited or acquired factors, including coagulation cascade protein defects (e.g., Factor V Leiden), oral contraceptive use, and pregnancy.
Endothelial Damage: Damage to the blood vessel wall, which can expose collagen and trigger the clotting cascade.

Diagnosis

Test	Purpose	Notes
D-dimer	Rule out DVT in low-to-moderate risk	High sensitivity, low specificity
Compression Ultrasound with Doppler	Imaging test of choice	Confirms diagnosis by visualizing clot in the vein

Diagnosis

Management

Prophylaxis and Acute Management:
- Unfractionated Heparin: Commonly used in hospital settings for quick anticoagulation.
- Low-Molecular-Weight Heparins (e.g., Enoxaparin): Preferred for their predictable pharmacokinetics and ease of administration.
Treatment and Long-Term Prevention:
- Oral Anticoagulants (e.g., Rivaroxaban, Apixaban): These are used for ongoing treatment and to prevent future clot formation.

Points to Remember

Most pulmonary emboli originate from proximal deep veins in the lower extremities.
The D-dimer test is useful in ruling out DVT but has low specificity.
Compression ultrasound with Doppler is the preferred diagnostic imaging technique.
Early intervention with anticoagulation is crucial in preventing complications such as pulmonary embolism.

Bibliography

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U01.16.027 Deep Venous Thrombosis (DVT)

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