dvt 1.pptx

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 1/52

Deep vein

thrombosis

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 2/52

Semisolid coagulum within fowing blood invenous system

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 3/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 4/52

Patient actorsAge

Obesity

Varicose veinsImmobility

Pregnancy   Puerperium

High-dose oestrogen

therapyPrevious V! or P"

 !hrombophilia

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 5/52

iseaseSurgery# !rauma

$alignancy

Heart ailure%ecent $I

Paralysis o lowerlimb

Inection

Infammatory boweldisease

&ephrotic syndrome

Polycythaemia

Paraproteinaemia

P&H'eh(et)s disease

Homocystinaemia

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 6/52

 !hrombophiliaCongenital

 e*ciency o anti-thrombin III# protein +

or protein S

Antiphospholipidantibody or lupusanticoagulant

,actor V eiden genedeect or activatedprotein + resistance

ys*brinogenaemias

Acquired

Antiphospholipidantibody or lupusanticoagulant

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 7/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 8/52

+linical eaturesPain and swelling o

cal 

%edness

"ngorged super*cialveins

 cramp in the lower

cal that persists or

several days and

becomes moreuncomortable as time

progresses.

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 9/52

Pittng edema

ilated veins

Sti/ cal !ender vein course

Homans sign

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 10/52

+linical eaturesFeatures of PE

 $assive - yspnea# syncope# hypotension#

cyanosissmall - situated distally near the pleura-

pleuritic pain# cough# or hemoptysis

0classic0 signs- tachycardia# low-grade ever#

nec1 vein distention# and an accentuated P 2

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 11/52

Venous gangrene

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 12/52

%uptured ba1er)s cyst#

+al muscle haematoma# %uptured plantaris muscle#

 !hrombosed popliteal aneurysm

 Arterial ischemia

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 13/52

 Diagnosis

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 14/52

Clinical variable Score

Active cancer 3Paralysis # paresis# recent cast 3

'edridden or4 5 days # ma6or surgery

7 32 wee1s

3

!enderness along deep veindistribution

3

"ntire leg swelling 3

8nilateral cal swelling 45 cm 3

Pitting edema 3

+ollateral super*cial non varicose veins 3

Alternate dia nosis at least li1el as -2 9: # $ 3#2 H;5

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 15/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 16/52

Venous 8S<3 ac1 o vein compressibility=principal>

Absence o ?win1@ on crosssection

,ailure to oppose walls dueto passive distension

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 17/52

2 !hrombus

homogenous # lowechogenecity

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 18/52

5 +al compression blunts

doppler fow signal

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 19/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 20/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 21/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 22/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 23/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 24/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 25/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 26/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 27/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 28/52

Management

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 29/52

ProphylaisLow B young# minor illness # operations

lasting 75:

Moderate B 4 C: or with a debilitating illnesswho are to undergo ma6or surgery.

igh B 3> 4C: who have seriousaccompanying medical conditions= +VA $I>#

  2>ma6or surgery with an additional ris1actor =past history o venousthromboembolism or 1nown malignantdisease.>

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 30/52

High-ris1 general surgery-$ini-8,H or  $EH

 !horacic surgery- $ini-8,H FIP+

 +ancer surgery - $EH#consider 3 month oprophylais

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 31/52

  !otal hip replacement#

total 1nee replacement# hipracture - $EH#ondaparinu

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 32/52

&eurosurgery - IP+

&eurosurgery or brain tumor-$ini-8,H or  $EH# F IP+ Fpredischarge venous

ultrasonography $edically ill patients- $ini-8,H or  $EH

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 33/52

Anticoagulationcontraindicated - IP+

ong-haul air travel - $EHor very high-ris1 patients

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 34/52

 !reatment G

anticoagulationInitiation G 8,H # $EH #ondaparinu

Proven HI! G direct thrombininhibitor G agatroban #

lepirudin # bivalirudin$aintenance G wararin

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 35/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 36/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 37/52

AP!! G 2 -5

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 38/52

iv bolus - :::-3:::: 8

ollowed by inusion 3:::-3::8hr

Short t J

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 39/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 40/52

<reater bio availability #

predictable # longer tJ"noaparin

alteparin

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 41/52

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 42/52

,ondaparinu G anti Ka

pentasaccharide&o lab monitoring no HI!

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 43/52

Eararin

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 44/52

Initiated in mg dose

 !arget I&% 2. =2-5>

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 45/52

urationP" ater surgery# trauma#

or estrogen eposure-have a low rate orecurrence ater 5GLmonths oanticoagulation.

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 46/52

 V! isolated to an upperetremity or cal that has been

provo1ed by surgery# trauma#estrogen# or an indwelling centralvenous catheter or pacema1er- 5

months o anticoagulationsuMces.

 ,or provo1ed proimal leg V!

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 47/52

 cancer and V!"# 5GL monthso $EH as monotherapywithout wararin and tocontinue anticoagulation

inde*nitely unless the patientis rendered cancer-ree.

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 48/52

 Idiopathic# unprovo1ed

V!"# =incl long-haul airtravel> anticoagulationor an inde*nite durationwith a target I&% between2 and 5

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 49/52

.moderate or high levels oanticardiolipin antibodies -inde*nite-durationanticoagulation even i the

initial V!" was provo1ed bytrauma

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 50/52

,ibrinolysis

rtPA

Iliac vein thrombosis

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 51/52

IV+ *lters

7/26/2019 dvt 1.pptx

http://slidepdf.com/reader/full/dvt-1pptx 52/52

Active bleeding

%ecurrent venousthrombosis despiteanticoagulation