10- Deep vein thrombosis. Clinical presentation, investigation, treatment options, early and late complications.

what is a DVT

• formation of blood clot in deep vein- in lower extremities

  • iliac, femoral, popliteal

• complication→ PE

• DVT + PE → venous thromboembolism

what are the predisposing risk factors

• advanced age

• immobility

• previous VTE

• obesity

• pregnancy- estrogen

• thrombophilias

• hormonal treatment

• kidney failure

• IBD

• malignancy

what are the provoking factors

• surgical intervention

• major trauma

• acute HF

• acute respiratory failure

• central venous catheter

what is the pathomechanism of DVT

• Virchow’s triad

  • endothelial injury

  • hypercoagulability

  • abnormal blood flow/ venous stasis

what are the steps of diagnosing DVTs

• anamnesis

• physical examination, clinical signs

• lab- D dimer

• instrumental exam

  • Duplex US, phlebography, CT, MR

what are the symptoms

• localised unilateral symptoms

• swelling, feeling of tightness or heaviness

• warmth, erythema, livid discolouration

• distention of superficial veins

• prorogressive tenderness, dull pain

what are the different signs of DVTs

• Homan sign

  • calf pain on dorsiflexion of foot

• Meyer sign

  • compression of calf causes pain

• Payr pain

  • pain when pressure is applied over medial part of sole of foot

what are the symptoms of PE

• dyspnea

• chest pain

• dizziness

• weakness

what is the Well’s score

describe the DVT diagnostic algorithm

what do you do in pts with suspected PE without haemodynamic instability

what do you do in pts with suspected PE with haemodynamic instability

what is the treatment of DVTs

• anticoagulants

• thrombolysis

• thrombectomy

• IVC filter

what is the acute anticoagulant therepy

• 5-10 days

• LMWH or UH

• fondaparinux

what is the long term anticoagulant prophylaxis

• 3-6months

• warfarin

• OAC- rivaroxaban

what is thrombolysis

• faster clot dissolution and better clinical outcome than anticoagulants

• indication= recurrent, extensive or proximal DVT

• streptokinase, urokinase, tPA

• catherer directed thrombolysis

what is thrombectomy

• intravenous thrombus removal via catheter

• indication- insufficient response to anticoagulation/ thrombolysis and extensive thrombus

• low dose heparin needed before procedure

what is IVC filter

• indicated in DVT patients at high risk of developing PE who have contraindication to anticoagulation, thrombolysis and thrombectomy

what are the complications of DVT

• PE

• CVI

• post thrombotic syndrome

what is post thrombotic syndrome

• symptoms and signs of CVI that develop after DVT

• reflux due to valve insufficiency and venous HT due to thrombotic obstruction

• symptoms/ signs

  • leg pain, heaviness, vein dilation, oedema, skin pigmentation, venous ulcer