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Deep vein thrombosis

Deep vein thrombosis. Color duplex scan of DVT. Venogram shows DVT. Patient with suspect symptomatic Acute lower extremity DVT. negative. Venous duplex scan. Low clinical probability. observe. High clinical probability. positive. negative.

serina-stephenson
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Deep vein thrombosis

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  1. Deep vein thrombosis

  2. Color duplex scan of DVT

  3. Venogram shows DVT

  4. Patient with suspect symptomatic Acute lower extremity DVT negative Venous duplex scan Low clinical probability observe High clinical probability positive negative Evaluate coagulogram /thrombophilia/ malignancy Repeat scan / Venography IVC filter Anticoagulant therapy contraindication yes No pregnancy LMWH OPD LMWH + warfarin hospitalisation UFH Compression treatment

  5. Thrombophilia screeningFactor V leiden, Prot C/S deficiency Antithrombin III deficiency • Idiopathic DVT < 50 years • Family history of DVT • Thrombosis in an unusual site • Recurrent DVT

  6. Recommendation for duration of warfarin • 3-6 months first DVT with reversible risk factors • At least 6 months for first idiopathic DVT • 12 months to lifelong for recurrent DVT or first DVT with irreversible risk factors malignancy or thrombophilic state

  7. Diagram 6

  8. Phlegmasia cerulea dolensVenous gangrene

  9. Catheter directed-thrombolysis • Consider in: Acute< 10 days iliofemoral DVT. • Long-term benefit in preventing post-phebitic syndrome is unknown.

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