Inconclusive findings on compression US.Venography, CT venography, or MR venography Screen for subtherapeutic INR in patients on VKA therapy with suspected recurrent DVT.Assess the patient's baseline coagulation status.These are recommended to assess organ function and bleeding risk prior to anticoagulation. Īdditional evaluation Routine laboratory studies If the study is negative, further investigations (e.g., a whole leg ultrasound study by radiology) may be necessary. If appropriately trained, consider performing a POCUS study to quickly rule in a proximal DVT. Point of care ultrasound study ( POCUS) by trained nonradiologists: equivalent accuracy for detection of proximal DVT, but distal DVT may be missed Ĭompression ultrasound of the whole leg with color Doppler (i.e., duplex scanning) is the most accurate test for diagnosing DVT.Whole leg study by radiology: high sensitivity and specificity ( ∼ 95% ) for proximal DVT lower sensitivity and specificity ( ∼ 65% ) for distal DVT.Accuracy: operator- and technique-dependent.Negative ( 4 mm increase in noncompressibility of the obstructed vein.Check D-dimer first for low PTP (initial D-dimer is not diagnostically helpful for intermediate and high PTP).Calculate the pretest probability ( PTP) using Wells criteria for DVT.This approach is valid for evaluating a first-episode or recurrent lower extremity DVT. Remember DVT risk factors using the mnemonic “ THROMBOSIS”: Travel, Hypercoagulable/ HRT, Recreational drugs, Old ( > 60), Malignancy, Blood disorders, Obesity/ Obstetrics, Surgery/ S moking, Immobilization, Sickness ( CHF/ MI, IBD, nephrotic syndrome, vasculitis)!ĭiagnostic approach for suspected lower-extremity DVT Antithrombin III deficiency, protein C deficiency, and protein S deficiency.Anatomic predisposition to venous stasis (e.g., compression of the iliac veins due to pelvic malignancy, May-Thurner syndrome).Personal or family history of DVT or PE.Implanted pacemaker or cardiac defibrillator leads.Lower extremity injury with restricted mobility for ≥ 3 days.Acute illness requiring complete bed rest.Primary prevention of VTE is recommended in patients at risk of DVT or PE (e.g., seriously ill medical patients, most surgical patients, and long-distance travelers with additional risk factors for VTE) and includes mechanical and pharmacological measures. Catheter-directed thrombolysis or thrombectomy may be considered for limb-threatening ischemia, acute iliofemoral DVT, and patients with contraindications to anticoagulation. Secondary prevention (i.e., anticoagulation extended indefinitely after completion of primary treatment) is also recommended for select patients, depending on the extent and etiology of the DVT and on the patient's bleeding risk.
#Deep vein thrombosis serial
Primary treatment with long-term anticoagulation for 3–6 months is recommended in all patients with DVT, with the exception of isolated asymptomatic distal DVT, for which expectant management with serial ultrasound may be considered, as the risk of postthrombotic sequelae is low. Noncompressibility of the affected vein is the most important sonographic feature of DVT.
A negative D-dimer assay (i.e., levels < 500 ng/mL) allows DVT to be ruled out, while a positive D-dimer (levels ≥ 500 ng/mL) is nonspecific and requires a venous ultrasound to confirm the diagnosis. The initial test of choice for DVT is D-dimer in patients with a low PTP and venous ultrasound (US) in patients with moderate or high PTP. The Wells criteria for DVT are used to determine the pretest probability ( PTP) of DVT. Patients may also present with features of pulmonary embolism ( PE), a severe complication of DVT.
Symptoms include edema, warmth, and dull pain of the affected extremity. The main risk factors for DVT are vascular endothelial damage (e.g., surgery or trauma), venous stasis (e.g., immobility), and hypercoagulability (e.g., thrombophilia), collectively referred to as the Virchow triad. Deep vein thrombosis (DVT) is the formation of a blood clot within the deep veins, most commonly those of the lower extremities.
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