DEEP VEIN THROMBOSIS

CARLA C. FERNÁNDEZ SANTOS

UNIVERSIDAD CENTRAL DEL CARIBE,
BAYAMÓN, PR
FAMILY MEDICINE
DEEP VEIN
THROMBOSIS (DVT)
• DEEP VEIN THROMBOSIS IS THE
FORMATION OF A BLOOD CLOT IN ONE
OF THE DEEP VEINS OF THE BODY,
USUALLY THE LEG.
• BLOOD CLOT: GELATINOUS MASS
OF BLOOD CELLS AND FIBRINS THAT
OCCURS WHEN THE BLOOD
HARDENS INSIDE OF A VESSEL.
 EPIDEMIOLOGY

• 1 PERSON IN 20 WILL DEVELOP A DVT IN THE COURSE OF THEIR LIFETIME.

• 600,000 HOSPITALIZATIONS PER YEAR OCCUR IN THE UNITED STATES.
• 80 CASES PER 100,000 POPULATION OCCUR ANNUALLY
• THE EXACT INCIDENCE OF DVT IS UNKNOWN BECAUSE MOST STUDIES ARE
LIMITED BY THE INHERENT INACCURACY OF CLINICAL DIAGNOSIS. EXISTING DATA
UNDERESTIMATES THE TRUE INCIDENCE.
 EPIDEMIOLOGY
• USUALLY AFFECTS INDIVIDUALS OLDER THAN 40 YEARS.
• >65 YEARS INCREASES FOUR-FOLD.
• THE MALE-TO-FEMALE RATIO IS 1.2:1, INDICATING THAT MALES HAVE A HIGHER RISK OF
DVT THAN FEMALES.
• ASIAN AND HISPANIC POPULATIONS HAVE A LOWER RISK OF VTE, WHEREAS WHITES AND
BLACKS HAVE A HIGHER RISK (2.5-4 TIMES HIGHER).
• 5 MILLION PEOPLE HAVE VENOUS STASIS AND VARYING DEGREES OF VENOUS
INSUFFICIENCY.
• ONE-THIRD (ABOUT 33%) OF PEOPLE WITH DVT/PE WILL HAVE A RECURRENCE
WITHIN 10 YEARS.
 Birth Endothelial
control Injury
pills

Stasis Overweight

Hypercoagulability Risk Family Hx

Factors/ Smoking
Causes
Pregnancy

Cancer
Heart
Surgery Failure
 SIGNS & SYMPTOMS
• SWELLING
• GRADUAL ONSET OF PAIN
• REDNESS
• WARMTH TO THE TOUCH
• WORSENING LEG PAIN WHEN BENDING
THE FOOT
• LEG CRAMPS, ESPECIALLY AT NIGHT, AND
OFTEN STARTING IN THE CALF
• BLUISH OR WHITISH DISCOLORATION OF
SKIN
 DIFFERENTIAL DIAGNOSIS
• BAKER'S CYST • POPLITEAL VENOUS OR ARTERIAL ANEURYSM
• CELLULITIS • ENLARGED LYMPH NODES COMPRESSING THE
VEINS
• LYMPHEDEMA
• HETEROTOPIC OSSIFICATION
• CHRONIC VENOUS INSUFFICIENCY
• HEMATOMA
• SUPERFICIAL THROMBOPHLEBITIS
• MUSCLE TEARS
• PULMONARY THROMBOEMBOLISM
 DIAGNOSIS

• DVT IS CHARACTERIZED BY PAIN AND SWELLING OF THE LIMB, WHICH ARE NOT SPECIFIC.
• NUMEROUS PATIENTS WITH DVT ARE ASYMPTOMATIC.
• HOMAN’S SIGN NOT USEFUL.

• WELLS CRITERIAà D-DIMERà COAGULATION WORK-UPà

RADIOLOGIC STUDIES
DIAGNOSIS: PRE-TEST
DIAGNOSIS
 LABORATORIES & RADIOLOGIC STUDIES

Doppler Ultrasound Venography MRI

D-dimer level >2.0 μg/ml

 PATHOPHYSIOLOGY

Vessel trauma, Platelets aggregate

immobility can at the site particularly Platelets & Fibrin RBC’s get trapped in
stimulate a clotting when venous stasis is form the initial clot the fibrin meshwork
cascade present

The thrombus Inflammation is Pieces of thrombi may

propagates in the Thrombus gets stuck triggered, causing break loose and
inside veins (close to travel through
direction of the blood venous valves) tenderness, swelling &
flow erythema circulationà Emboli
 COMPLICATIONS
• PULMONARY EMBOLISM
• MOST SERIOUS COMPLICATIONS.
• IN MANY CASES, IT CLOGS THE VEINS IN THE LUNGS, PREVENTING
BLOOD FLOW TO THE LUNGS. THIS WILL CERTAINLY BE FATAL FOR
IT LEADS TO INSUFFICIENT OXYGEN TO ORGANS IN THE BODY.
• CHRONIC VENOUS INSUFFICIENCY
• LONG TERM DVT CAN DAMAGE VENOUS VALVES
• POST-PHLEBOTIC SYNDROME
• DUE TO DAMAGE AND SCARRING TO THE VEINS AND IS
CHARACTERIZED BY SWELLING, DISCOMFORT & SKIN
PIGMENTATION IN AFFECTED AREAS.
 TREATMENT
• ANTICOAGULANT MEDICATION IS NORMALLY A FIRST STEP TOWARDS TREATMENT OF THE
CONDITION. THIS MEDICATION IS AIMED AT STOPPING THE BLOOD FROM CLOTTING, NOT
DISSOLVING ALREADY EXISTING CLOTS.
• UNFRACTIONATED HEPARIN OR LOW MOLECULAR WEIGHT HEPARIN FOR ACUTE & PROPHYLAXIS
MANAGEMENT

• THROMBOLYSIS MAY INVOLVE THE INJECTION OF CLOT-BUSTING DRUGS THROUGH AN

INTRAVENOUS (IV) LINE OR THROUGH A LONG CATHETER THAT DELIVERS DRUGS DIRECTLY TO
THE SITE OF THE BLOCKAGE.
• IT ALSO MAY INVOLVE THE USE OF A LONG CATHETER WITH A MECHANICAL DEVICE ATTACHED TO
THE TIP THAT EITHER REMOVES THE CLOT OR PHYSICALLY BREAKS IT UP.
• STREPTASE (STREPTOKINASE, KABIKINASE)
• T-PA
TREATMENT
• VENA CAVA FILTERS TREATMENT
• ANGIOPLASTY WHICH INVOLVES THE
SURGICAL REPAIR OF THE VEINS FOR
PEOPLE WITH POST THROMBOTIC
SYNDROME (PST).
• GRADUATED COMPRESSION
STOCKINGS
 PREVENTION

• EMBRACE A HEALTHY LIFESTYLE

• STOP SMOKING
• MAINTAIN A HEALTHY WEIGHT
• AFTER LONG PERIODS OF SITTING OR TRAVELING: WALK AROUND FOR 2-3 HOURS
• EXERCISE LOWER EXTREMITIES
• LOOSE-FITTING CLOTHES
 FOLLOW UP

• ANTICOAGULATION IS RECOMMENDED FOR A MINIMUM OF THREE MONTHS IN A

PATIENT WITH DVT.
• RE-SCAN TO ASSESS RESOLUTION PRIOR TO DISCONTINUATION OF TREATMENT.
• PATIENTS WITH UNPROVOKED DVT: INVESTIGATE FOR A POSSIBLE MALIGNANCY
• PREVENTION OF RECURRENT DVT: WARFARIN AND RIVAROXABAN
• BELOW THE KNEE COMPRESSION STOCKINGS.
EVIDENCE-BASED MEDICINE

The American College of Chest Physicians

CURRENT RESEARCH
 BIBLIOGRAPHY
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DOI:10.1053/J.SEMINHEMATOL.2007.02.004
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• MA J, LI X, WANG Y, YANG Z, LUO J. RIVAROXABAN ATTENUATES THROMBOSIS BY TARGETING THE NF-ΚB SIGNALING
PATHWAY IN A RAT MODEL OF DEEP VENOUS THROMBUS [RETRACTED IN: INT J MOL MED. 2018 JUN;41(6):3736]. INT J
MOL MED. 2017;40(6):1869–1880. DOI:10.3892/IJMM.2017.3166
• SWANSON E. ULTRASOUND SCREENING FOR DEEP VENOUS THROMBOSIS DETECTION: A PROSPECTIVE EVALUATION
OF 200 PLASTIC SURGERY OUTPATIENTS. PLAST RECONSTR SURG GLOB OPEN. 2015;3(3):E332. PUBLISHED 2015 APR
7. DOI:10.1097/GOX.0000000000000311
• KITCHEN L, LAWRENCE M, SPEICHER M, FRUMKIN K. EMERGENCY DEPARTMENT MANAGEMENT OF SUSPECTED CALF-
VEIN DEEP VENOUS THROMBOSIS: A DIAGNOSTIC ALGORITHM. WEST J EMERG MED. 2016;17(4):384–390.
DOI:10.5811/WESTJEM.2016.5.29951
• HTTPS://WWW.HEMATOLOGY.ORG/NEWSROOM/PRESS-RELEASES/2018/8958.ASPX#
• NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES, CENTERS FOR DISEASE CONTROL AND
PREVENTION, CENTERS FOR DISEASE CONTROL AND PREVENTION