Deep vein thrombosis resident survival guide: Difference between revisions
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{{Family tree | | B01 | | B02 | | B03 | | | |B01='''Hemodynamically unstable(massive PE)'''<br>SBP<'''90 '''mm Hg or '''40''' mm Hg drop<br> Syncope<br>Severe hypoxemia or respiratory distress<br>|B02=Hemodynamically stable|B03=Contraindication for Anticoagulation therapy<br>'''Absolute'''<br>Active severe hemorrhage <br>Intracranial hemorrhage<br>'''Relative'''<br>Recent surgery, trauma, anemia,GI bleeding, PUD }} | {{Family tree | | B01 | | B02 | | B03 | | | |B01='''Hemodynamically unstable(massive PE)'''<br>SBP<'''90 '''mm Hg or '''40''' mm Hg drop<br> Syncope<br>Severe hypoxemia or respiratory distress<br>|B02=Hemodynamically stable|B03=Contraindication for Anticoagulation therapy<br>'''Absolute'''<br>Active severe hemorrhage <br>Intracranial hemorrhage<br>'''Relative'''<br>Recent surgery, trauma, anemia,GI bleeding, PUD }} | ||
{{Family tree | | |!| | | |!| | | |!| | | | | }} | {{Family tree | | |!| | | |!| | | |!| | | | | }} | ||
{{Family tree | | C01 | | C02 | | C03 | | | |C01=Thrombolytic therapy|C02=LMWH<br> or UFH(target INR:2.5, monitor Plt count)+ Warfarin|C03=IVC filter }} | {{Family tree | | C01 | | C02 | | C03 | | | |C01=Thrombolytic therapy|C02=LMWH<br> or UFH(target INR:2.5, monitor Plt count)+ Warfarin <br>or Fondaparinux|C03=IVC filter }} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 17:22, 9 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Abdurahman Khalil, M.D. [2]
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
| DVT confirmed | |||||||||||||||||||||||||||||||
| Hemodynamically unstable(massive PE) SBP<90 mm Hg or 40 mm Hg drop Syncope Severe hypoxemia or respiratory distress | Hemodynamically stable | Contraindication for Anticoagulation therapy Absolute Active severe hemorrhage Intracranial hemorrhage Relative Recent surgery, trauma, anemia,GI bleeding, PUD | |||||||||||||||||||||||||||||
| Thrombolytic therapy | LMWH or UFH(target INR:2.5, monitor Plt count)+ Warfarin or Fondaparinux | IVC filter | |||||||||||||||||||||||||||||
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.