Deep vein thrombosis
Deep Vein Thrombosis
Symptoms
Deep vein thrombosis signs and symptoms can include:
Swelling in the affected leg. Rarely, there’s swelling in both legs.
- Pain in your leg. The pain often starts in your calf and can feel like cramping or soreness.
- Red or discoloured skin on the leg.
- A feeling of warmth in the affected leg.
Deep vein thrombosis can occur without noticeable symptoms.
Risk factors
Many factors can increase your risk of developing deep vein thrombosis (DVT). The more you have, the greater your risk of DVT. Risk factors include:
• Age >40y
• Smoking
• Obesity
• Immobility
• Recent long-distance travel
– Pregnancy
Puerperium
• HRT use/ Oral combined contraceptives
• Surgery
• Recent trauma
• Malignancy
• Heart failure
• Nephrotic syndrome
Inflammatory bowel disease
PMH of venous thromboembolism
• Inherited thrombophilic
Clotting disorders
• Other chronic illness
Complications
Pulmonary Embolism
Postphlebitic syndrome
Postphlebitic syndrome
A common complication that can occur after deep vein thrombosis is known as postphlebitic syndrome also called a postthrombotic syndrome.
- Persistent swelling of your legs (oedema)
- Leg pain
- Skin discolouration
- Skin sores
Diagnosis
Doppler venous Ultrasound – Diagnostic
D- dimer
Well’s score to assess risk
If low probability A blood D-dimer test is done. If the D-dimer test is–ve, DVT is excluded. If +ve, the patient is assessed with Doppler venous Ultrasound
Management
Initial anticoagulation is with LMWH followed by oral anticoagulation such as warfarin.
LMWH should be continued for at least 4d and until INR is in the therapeutic range for ≥2d. Target INR 2.5 (range 2–3)
Graduated elastic compression stockings
The choice of anticoagulation and duration is generally decided by the specialist.
Recently new anticoagulants have been used more frequently such as Eliquis etc (No need to monitor INR)