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DVT • There are a number of questions that arise when a patient is suspected of having deep vein thrombosis (DVT) of the lower extremity.
DVT • What is the differential diagnosis and what are the possible risk factors for DVT? • What is the best way to diagnose or exclude DVT?
DVT • What is the appropriate initial therapy for DVT; when is hospitalization not required? • What is the recommended long-term treatment for DVT (e.g., agents to use, monitoring the degree of anticoagulation, length of time treatment is needed)?
DVT INITIAL APPROACH • When approaching the patient with suspected DVT of the lower extremity, it is important to appreciate that only a minority of patients actually have the disease and will require anticoagulation.
DVT • This illustrates the importance of using validated algorithms to evaluate patients with suspected DVT, along with objective testing to establish the diagnosis. • Given the potential risks associated with proximal lower extremity DVT that is not treated (e.g., fatal pulmonary emboli) and the potential risk of anticoagulating a patient who does not have a DVT (e.g., fatal bleeding), accurate diagnosis is essential.
DVT History • Classic symptoms of DVT include swelling, pain, and discoloration in the involved extremity. • There is not necessarily a correlation between the location of symptoms and the site of thrombosis.
DVT History • A complete thrombosis history includes the age of onset, location of prior thromboses, and results of objective diagnostic studies documenting thrombotic episodes in the patient, as well as in any family members. • A positive family history is particularly important, since a well documented history of venous thrombosis in one or more first-degree relatives strongly suggests the presence of a hereditary defect.
DVT History • Recent potential precipitating conditions • Underlying conditions: i.e. cancer, collagen-vascular disorders • Medications
