DEEP VEIN THROMBOSIS

DEFINITION

• Deep venous thrombosis is defined as formation of thrombus in the deep veins

which is more common in the lower limbs.
CAUSES AND RISK FACTORS.

A) Primary(genetic) risk factors.

• deficiency of antithrombotic factors- eg Antithrombin III deiciency, protein C and S
deficiency
• increased prothrombotic factors
B) Secondary(acquired) risk factors
• SURGERY: major abdominal/pelvic, hip/knee surgeries
• OBSTETRICS: pregnancy, postpartum

• CARDIORESPIRATORY DISEASE: COPD, congestive cardiac failure.

• LOWER LIMB CONDITIONS: fracture, varicose veins
• APLA synderome etc.

SITES OF DEEP VEIN THROMBOSIS

• most commonly in lower extremities.

• other systemic veins like pelvic veins.

• right side of heart: atrium in patients with atrial fibrillation and cardiac failure.
CLINICAL FEATURES.
• most often in 50% of patients DVT is asymptomatic.
• they are usually unilateral but can occasionally be bilateral,
• major presenting features are:

1. pain or tenderness or both in the calf

2. swelling( ankle edema)

3. redness

4. increased temperature of the affected calf

5. dilatation or engorgement of the superficial veins.
• Homan’s sign: pain in posterior calf in a dorsiflexed foot with extended knee.
• Moses test: tenderness over calf muscles on squeezing muscles side to side.
• both the above mentioned tests are not performed nowadays due risk of develepment of
pulmonary embolism.
• thrombosis in ileofemoral region: severe pain, swelling of the thigh and/or ankle edema.

• complete occlusion of large vein: cyanosis of the limb, severe edema, and sometimes
venous gangrene.
DIAGNOSIS OF DVT.
• Diagnosis is with help of Wells clinical prediction/ Wells probability score.
• high risk >3, moderate risk 1-2, low risk 0
CLINICAL FEATURES SCORE
Active cancer +1
paralysis or recent plaster immobilisation of the lower extremities +1
recent bedridden for > 3 days or major surgery < 4 week +1
localised tenderness along the distribution of the deep veins +1
swelling of entire leg +1
calf swelling > 3 cm compared to the asymptomatic leg +1
pitting edema +1
previously documented DVT +1
collateral superficial veins +1
alternative diagnosis -2
COMPLICATIONS.
• Pulmonary embolism

• post thrombotic syndrome: edema, skin pigmentation, venous eczema, ulceration around
the medial malleolus, venous claudication, nocturnal clamping and lifelong pain in the
involved pain.
• venous gangrene: due to complete obstruction of large veins.
INVESTIGATIONS
A) D-Dimer assay: may be raised in trauma, recent surgery, hemorrhage. but in DVT it stays
raised for 7 days.
• Negative: rules out DVT in patients with low to moderate risk. no further investigations
needed
• Positive: moderate to high risk of DVT. furrther investigations needed like DOPPLER
ULTRASONOGRAPHY.
B) B mode venous compression, ultrasonography or doppler.
C) contrast venography.

D) impedance plethysmography(IPG)
E) radiofibrinogen scanning.
PROPHYLAXIS OF DVT
A) NON PHARMACOLOGICAL MEASURES:
• Anti embolism stockings.
• foot impulsive devices
• physiotherapy

• intermittent pneumatic compression devices.

B) PHARMACOLOGICAL PROPHYLAXIS:
• low molecular weight heparin or unfractioned heparin.

• when risk factors are present treatment with warfarin to be given for prolonged time.
TREATMENT OF DVT
• bed rest till the patient is fully anticoagulated.

• elevation of leg by 15 degrees and physiotherapy.