DVT

What is deep vein thrombosis (DVT)?

Blocks blood flow in deep veins, often in legs.

Where does DVT most commonly occur?

Primarily in the legs, but can affect the pelvis.

What is the overall incidence of venous thromboembolism (VTE), including DVT?

1-2 cases per 1,000 people annually.

What proportion of VTE cases are DVTs?

DVTs account for two-thirds of VTE cases.

How common is DVT in critically ill patients?

Incidence can reach up to 37%.

What is the incidence rate of DVT specifically?

Approximately 100 cases per 100,000 person-years.

At what age does DVT peak?

Incidence peaks between 60-70 years.

Is there a gender difference in DVT occurrence?

The sex ratio is approximately 1:1.

What is the primary mechanism behind DVT formation?

Results from venous thromboembolism due to risk factors.

What risk factors for DVT can be recalled with the THROMBOSIS mnemonic?

Includes thrombophilia, hormonal factors, and obesity.

What demographic factors increase DVT risk?

Older age and male gender are significant factors.

How do immobility and hospitalization affect DVT risk?

Immobilization and hospitalization significantly increase risk.

What role does malignancy play in DVT?

20% of DVT patients have cancer; screening is essential.

How do pregnancy and obesity contribute to DVT risk?

Pregnancy increases risk 5x; obesity 2-3x if BMI >30.

What are the three components of Virchow’s triad in DVT?

Hypercoagulability, blood stasis, and endothelial changes.

How does hypercoagulability contribute to DVT?

Increases clotting tendency due to genetic or acquired factors.

What role does blood stasis play in DVT formation?

Promotes clot formation, especially during immobilization.

How does endothelial damage lead to DVT?

Disruption of vein lining initiates thrombosis.

What is the most common presentation of DVT?

Unilateral swelling, warmth, pain, and erythema.

Where is the pain typically located in DVT?

Commonly in the lower leg, worsened by exertion.

How does swelling manifest in DVT?

Usually confined to calves; may cause whole-leg swelling.

What skin changes are seen in DVT?

Discoloration and distended superficial veins may occur.

Can DVT be asymptomatic?

Yes, up to 30% may show no symptoms.

How does a typical patient with DVT present?

A 65-year-old post-surgical patient with leg pain and swelling.

What might indicate a complication in a DVT patient?

Sudden shortness of breath may suggest pulmonary embolism.

What infectious condition mimics DVT?

Cellulitis presents with unilateral erythema and fever.

What traumatic condition can resemble DVT?

Calf muscle tear shows swelling and pain after trauma.

What vascular condition is similar to DVT?

Superficial thrombophlebitis causes localized pain and erythema.

What systemic condition might be confused with DVT?

Dependent edema presents as bilateral swelling.

What injury-related condition mimics DVT?

Ruptured Baker’s cyst causes calf pain and bruising.

What is the initial step in diagnosing suspected DVT?

Perform a two-level DVT Wells score.

What factors are included in the DVT Wells Score?

Includes active cancer, leg swelling, and prior DVT.

What does a Wells Score of 2 or more indicate?

DVT is likely; order a proximal leg vein ultrasound.

What follow-up is needed if the initial ultrasound is negative with a Wells Score ≥2?

Perform a D-dimer test to rule out DVT.

What should be done if ultrasound is delayed with a Wells Score ≥2?

Conduct a D-dimer test and start interim anticoagulation.

What does a Wells Score of 1 or less indicate?

DVT is unlikely; perform a D-dimer test.

What follow-up is needed if the D-dimer is positive with a Wells Score ≤1?

Order a proximal leg vein ultrasound within 4 hours.

What if the D-dimer is negative with a Wells Score ≤1?

DVT is unlikely; stop anticoagulation if started.

What should be done if the initial ultrasound is negative but D-dimer is positive?

Repeat ultrasound in 6-8 days.

What type of D-dimer test is recommended for DVT?

Point-of-care or laboratory-based tests with age adjustments.

What baseline blood tests are needed when starting anticoagulation for DVT?

FBC, U&Es, LFTs, and coagulation screen.

What is the first-line treatment for DVT?

Direct oral anticoagulants like apixaban or rivaroxaban.

What are the second-line anticoagulation options for DVT?

LMWH for ≥5 days followed by dabigatran or warfarin.

How is anticoagulation adjusted for specific conditions in DVT?

Tailored based on cancer status and renal function.

What is the minimum duration of anticoagulation for DVT?

At least 3 months for all patients.

How long should anticoagulation continue for provoked DVT?

Typically stopped at 3 months.

How is anticoagulation managed for unprovoked DVT?

Consider continuing up to 6 months.

What additional steps are needed for unprovoked DVT?

Test for thrombophilia and screen for cancer.

What is the major complication of DVT?

Pulmonary embolism occurs in 40-50% of cases.

What is post-thrombotic syndrome in DVT?

Chronic venous hypertension causing pain and swelling.

Are compression stockings recommended to prevent post-thrombotic syndrome?

No, they are not advised for prevention.

How is post-thrombotic syndrome managed?

Use compression stockings and elevate the leg.

What are other complications of DVT treatment?

Includes gastrointestinal bleeding from anticoagulation.

What is the general outcome for DVT patients?

Most recover, but complications can affect quality of life.

How does prompt management affect DVT prognosis?

Timely treatment reduces PE risk and morbidity.