2 deep vein thrombosis.ppt
TRANSCRIPT
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Deep vein thrombosis
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Color duplex scan of DVT
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Venogram shows DVT
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Patient with suspect symptomatic Acute lower extremity DVTVenous duplex scannegative Low clinical probabilityobserve
High clinical probabilityRepeat scan /VenographynegativepositiveEvaluate coagulogram /thrombophilia/ malignancyAnticoagulant therapycontraindicationyesIVC filterNopregnancyLMWHOPDLMWHhospitalisationUFH+ warfarinCompression treatment
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Thrombophilia screeningFactor V leiden, Prot C/S deficiency Antithrombin III deficiency
Idiopathic DVT < 50 yearsFamily history of DVTThrombosis in an unusual siteRecurrent DVT
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Recommendation for duration of warfarin
3-6 months first DVT with reversible risk factorsAt least 6 months for first idiopathic DVT12 months to lifelong for recurrent DVT or first DVT with irreversible risk factorsmalignancy or thrombophilic state
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Diagram 6
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Phlegmasia cerulea dolens Venous gangrene
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Catheter directed-thrombolysisConsider in: Acute< 10 days iliofemoral DVT.
Long-term benefit in preventing post-phebitic syndrome is unknown.