Deep Venous

Thrombosis
The subject: Internal
Medicine I
Subject professor: Dr. Guram
Rtskhiladze
BY: Juma Awar

UG: 1802018
 Introduction
 Deep vein thrombosis (DVT) occurs
when a blood clot (thrombus) forms in
one or more of the deep veins in the
body, usually in the legs, although it
rarely can affect the arms and the veins
inside the abdomen and the brain.

 The term ‘thrombosis’ should be

differentiated from ‘embolism’, which
denotes dislodgement of the clot from
the blood vessel where it developed,
and getting stuck elsewhere, most
commonly the lung, causing a
pulmonary embolism (PE). PE can
however rarely develop in the absence
of a DVT.
What causes DVT to develop?

 Virchow’s triad
1. Blood flow stasis
2. Blood
hypercoagulability
3. Endothelial damage
Blood flow stasis

 1. Atrial fibrillation
 2. Long travel in a plane or a car
 3. Post-operative
 4. Paralysis
 5. Varicose veins
 6. Compression due to pregnancy, may-Thurner syndrome, obesity
Blood hypercoagulability

 1. Genetic mutations in factor V Leiden or prothrombin gene mutation

 2. Inhibition of anticoagulant enzymes such as Antithrombin 3,
protein C, and protein S
 3. Estrogen therapy
 4. Malignancy (lung cancer, pancreatic cancer)
 5. Nephrotic syndrome
 6. Auto-phospholipid syndrome
Endothelial damage

 1. Trauma or surgery
 2. Smoking
 3. Obesity
 4. Venipuncture
 5. Chemical irritation
 6. Indwelling catheters
 Pathophysiology

Recruitment Release of
Virchow’s triad
of platelets microparticles

Formation of
Platelet neutrophil Stimulation of
aggregation extracellular neutrophils
traps

Venous Emboli to the

Thrombus lung or
thrombi
dislodge somewhere
formation
else
Pulmonary Embolism

 A blood clot that forms in a

blood vessel in one area of the
body, breaks off, and travels to
another area of the body in the
blood is called an embolus. An
embolus can lodge itself in a
blood vessel. This can block the
blood supply to a particular
organ. This blockage of a blood
vessel by an embolus is called
an embolism.
Pulmonary Embolism effect on lungs
Bronchoconstriction Lung infarction and pulmonary
hypertension
Pulmonary Embolism effect on heart

Pulmonary hypertension Dilated RV LV effected

Clinical features of DVT

 Patients with DVT

usually present with
throbbing or cramping
pain in 1 leg (rarely
both legs), usually in
the calf or thigh,
swelling in 1 leg
(rarely both legs),
warm skin around the
painful area, red or
darkened skin around
the painful area
Wells score
Chest CT Venous ultrasonography
Pulmonary angiography Lung scanning
 Treatment
Pulmonary Embolism

Hemodynamic stable Hemodynamic unstable

Contraindication Tissue plasminogen Contraindication

Anticoagulation
to anticoagulation activator to Tissue
• Unfractionated plasminogen
Heparin activator
• Low-Molecular-
Weight Heparins Inferior vena cava
• Novel Oral
filters
Embolectomy
Anticoagulants:
Rivaroxaban, apixaban
and Betrixaban

• Warfarin
THANK YOU