Deep Vein

Thrombosis

Oleh :
Ika Lukita Sari
10542017410
Definition

– a condition characterized by the discovery of blood clots in the deep veins,

especially in the lower limbs
– DVT of the lower limbs were divided into 2 major categories:
A. Calf- Vein thrombosis or DVT or distal part Thrombus is limited to
deep veins in the calf
B. Proximal vein thrombus thrombosis of the veins of the popliteal,
femoral, and iliaca
Epidemiology

– the incidence of venous thrombosis is very difficult to study, so there are no

reported with certainty
– venous thrombosis is related to various medical conditions or surgical
procedures. in patients undergoing pelvic and knee surgery, the incidence of
DVT is around 30% in Europe and 16% in the US, while the incidence data for
DVT in Asia is very limited.
Etiopathogenesis

– Triad Virchow
Endothelia
l injury

Abnormal
blood Thrombosis hypercoa
gulability
flow
– DVT there is an imbalance of blood clot formation and destruction
– There are three factors that play a role in the occurrence of deep vein
thrombosis :
– 1. Static Veins
Venous blood flow tends to be slow, even static in areas that have been
immobilized for a long time. Example : long immobilization and paralysis of the
extremities (in patients with stroke), obesity and varicose
– 2. Hypercoagulobility
– Normal condition the balance of blood coagulation and fibrinolysis
systems
– Thrombosis increased blood clotting activity or decreased fibrinolysis
activity
– Increased blood clotting hypercoagulation, deficiency of thrombin III,
protein C deficiency, protein S deficiency and plasminogen abnormalities
– Example : deficiency anti thrombin III, protein C, protein S and AlfaI anti tripsin,
pregnancy and childbirth, oral contraceptive medication.
– 3. Venous wall damage
• activation of clotting factors
• Platelets are attached to the sub-endothelial tissues, especially collagen fibers,
basement membranes and micro-fibrils release adenosine diphosphate and
thromboxane A2 stimulate other platelets to change shape and stick
together.
• Example : surgery in orthopedics and trauma in the pelvis and lower limbs
Clinical manifestations

– DVT will have complaints and symptoms when the cause:

o dam venous flow
o inflammation of the venous wall and perivascular tissue
o embolism in the pulmonary circulation
Signs and symptoms

1. Pain
– pain in the calf and can radiate to the medial and anterior part of the thigh.
2. Swelling
– swelling caused by edema. the onset of edema is caused by venous obstruction
in the proximal part and inflammation of the perivascular tissue .
3. Skin discoloration
– not specific and not much on DVT than arterial thrombosis
– only 17-20% of cases. Skin color can turn pale and sometimes purple.
4. Post- thrombosis Syndrome
– deep vein obstruction increased venous wall pressure incompetent
venous valves and deep venous perforation blood flow back to the
superficial veins if the muscles contract edema of subcutaneous tissue
damage can occur ulcers in affected venous areas.
Diagnostic

– Venography (Gold standart)

– D-Dimer test
– USG doppler
 Management DVT
1. Prophylaxis (Thromboprophylaxis)
– Thrombiphylaxis aimed at patients at risk DVT
 Mechanical method :
 Early mobilization : leg elevation of 15-22 cm venous blood flow
 Warm compresses improve microvascular circulation
 Range of motion : flexion extension. Increase blood flow in the open vein (patent).
 Wearing elastic stocking : increased venous blood flow 1.5x basal flow. The first choice for preventing DVT in patients who
are hospitalized for a long time

 Farmacology method :
 Heparin : increase the anti-thrombin III effect in neutralizing thrombin and other serum proteases. (dose : 5000 U/1 hour/
pre-post OP/ every 8-12 hours
 Warfarin : effective for preventing DVT in all patients at risk (dose: 5-10 mg night before surgery or after surgery) .
Prophylactic duration of warfarin use is 7-10 days
 LMWH (Low Molecular Weight Heparin) more effected. Increase the anti-thrombin III and Xa factor. Subcutaneously given 40
mg once a day, given 12 hours before surgery and continued once a day for 7 days.
 Anti platelet drugs : Aspirin (dose >100mg/day)
2. Therapy
– aimed at patients who are objectively diagnosed as DVT
– therapeutic goals prevent thrombus embolization, resolution of thrombus to
avoid post-phlebitis syndrome and accelerate fibrinolysis.
 Thrombolytic therapy
 Antikoagulan (save and efective)
 Heparin 4-5 days followed by warfarin to maintain thrombotic recurrence
protection. Side effects: bleeding, thrombocytopenia, hypersensitivity.
 LMWH : longer half-life, without laboratory monitoring, rarely causes bleeding,
thrombocytopenia and osteoporosis while the antitrobic effect is equivalent to
heparin. Can not penetrate the placental barrier, can be used in pregnant women.
Doses 2mg/kgW/days/subctaneous.
 Anticoagulan oral : need to be given after initial heparin therapy. Prevent DVT
recurrence. Using coumarin (warfarin) which is a vitamin K antagonist.
 Surgery
Indication :
 When anticoagulant therapy is ineffective
 Unsafe
 Contraindicated
 Filters
This tiny umbrella-likedevice is inserted into the vein to vatch blood clots and stop them moving up into the
lungs, while allowing blood flow to continue. It is inserted in the vena cava.
Complication

– Emboli Pulmoner (EP)

– Post-thrombosis syndrome (PTS) or post-phlebitis syndrome (PPS)
– Blood clot in the kidney (renal vein thrombosis)
– Blood clot in the heart, leading to heart attack
– Blood clot in the brain, leading to stroke
– Chronic venous insufficiency
Prognosis

– All patients with DVT are at long-term risk of developing chronic venous
insufficiency
– About 20% of untreated proximal (above the calf) DVT progress to pulmonary
emboli, and 10-20% of these are fatal. With aggressive anticoagulant therapy
the mortality is decreased 5 to 10 fold
Thank you