Presentation

Signs and Symptoms

• Unilateral leg swelling - redness, pain, warth along the deep vein system (inner leg)

  

• Severe case: affect arterial flow → cynosis & cold (Phlegmasia Cetula Dolens)

• Commonly found w/ PE

  !PE - Pulmonary embolism

Risk factors

• Virshow’s Triad
• Other RF
  • Male: increased risk of recurrence
  • PHx of DVT (esp. unprovoked)
  • FHx of DVT (first degree)
    • Genetic conditions increasing blood coagulability (e.g. protein C,S, antithrombin deficiency)
  • Hx of Antiphospholipid Antiboty syndrome (autoimmune condition)

Classifications

• Provoked: w/ significant trigger, which, without it DVT not occur
  • Surgery, Trauma
  • Pregnancy, Estrogen RT
  • Cancer, Chemotherapy,
  • Prolonged immobility (> 1d)
  • Hospitalization (> 3d)
  • Acute medical illness
• Unprovoked: w/t significant trigger
• Phlegmasia cerulea dolens: extreme DVT - cannot walk, potential risk of limb ischemia and amputation
  • ‘swelling, blue, pain’

Investigation

Decision Process (Diagram):

Management

Management Options

1. Anti-Coagulant - stop new clot from forming

   Medication: Common side effect: Bleeding

2. Thrombolysis - break down old clot - applied when patient is hemodynamically unstable (ABC compromised, life/limb threatening )

   Medication: tPA - systemic/catheter directed

   TNK-tPA (tenecteplase)

   Procedure: Thrombectomy