DEEP PAIN TROMBOSIS

THE MOST COMMON TYPE OF VENOUS

THROMBOEMBOLISM ( VTE )

is deep vein thrombosis ( DVT )

which occurs most frequently in veins deep
within the muscles of the leg and pelvis.

COMPLICATIONS OF DVT INCLUDE :

POTENTIALLY LIFE-THREATENING PE, in addition to

POST-THROMBOTIC SYNDROME (PTS).
DVT is usually the formation of a thrombus in the deep veins of the
leg,
may be referred to as proximal DVT or distal DVT extremities.

Occasionally, DVT also occurs in the veins of the upper extremities

DVT can occur spontaneously without known underlying cause

(idiopathic thrombosis)

DVT after provoking events, such as trauma, surgery or acute illne

(provoked thrombosis).
THE ANNUAL NUMBER OF DVT EVENTS IN THE

European Union ( EU ) is estimated at over 684,000;

In the United States (US) is estimated to be more than 376,000 per year
Diagnosis of DVT
Signs and symptoms
Leg pain,
Tenderness,
Oedema or swelling are typically associated with DVT
Definitively Diagnosed Validated objective diagnostic tests,
ultrasonography,
venography or
magnetic resonance imaging (MRI)
 Parameter ( PROGNOSTIC ) Score
Active cancer (treatment ongoing or within previous 6 months
1
or palliative)
Paralysis, paresis or recent plaster immobilization of lower
1
extremities
Recently bedridden for more than 3 days or major surgery
1
within 4 weeks
Localised tenderness along distribution of the deep vein
1
system
Entire leg swollen 1
Calf swelling by more than 3 cm when compared with
1
asymptomatic leg
Pitting oedema 1
Collateral superficial veins 1
Wells score
Alternative for prediction
diagnosis of DVT.
as likely or greater than that of DVT 2
DVT, deep vein thrombosis.
A high score is 3 or more, a moderate score 12
COMPRESSION ULTRASONOGRAPHY

Cross-sectional view of the popliteal by compression

ultrasonography vein showing partial obstruction of the vessel
COMPUTED TOMOGRAPHY VENOGRAPHY

CT Venography detects both distal and proximal DVT

MAGNETIC RESONANCE IMAGING

May be used to diagnose DVT in patients when ultrasound

examination is inappropriate or not feasible.

D-DIMER MEASUREMENTS

Plasmin dissolves the fibrin strands that hold a thrombus together.

D dimer blood tests vary in their accuracy.
None is specific for VTE, but some have high sensitivity
Risk factors for recurrence
Three important risk factors were identified and quantified in the
Vienna Prediction Model:
Initial proximal (rather than distal) DVT
Male gender
Elevated D-dimer concentration
Short-term (rather than long-term) duration of anticoagulation therapy
is also associated with recurrence.
Patients with a previous history of VTE,
Malignancy or
Haematological abnormality
Treatment of DVT and PE with anticoagulants

TRADITIONALLY,
Longer-term vitamin K antagonist (VKA) therapy,
Because VKAs have a delayed onset of action,
Often with warfarin.
monitoring of the international normalized ratio (INR),
should be in the therapeutic range (INR 2.03.0)
ACCP guidelines for the treatment of DVT,PE with anticoagulants
Grade of
ACCP recommendation
recommendation
Initial anticoagulation
Parenteral anticoagulation
Acute DVT or PE (overlapping with a VKA) or 1Ba
rivaroxaban
LMWH or fondaparinux

suggested over:
i.v. UFH 2C
s.c. UFH 2B
Thrombolytic therapy (for
PE with hypotension patients who do not have 2C
high risk of bleeding)
Long-term therapy
DVT or PE without
VKA suggested over LMWH 2C
cancer