Deep Vein Thrombosis
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- A constant balance exists between intravascular clot formation and clot dissolution, clot forming when the former overpowers the latter.
- Clot can be superficial (to the fascia) or deep. The latter is called deep vein thrombosis (DVT).
- Pulmonary embolism (PE) and DVT are different ends of the clinical spectrum of the same disease process (venous thromboembolism, VTE).
- DVT can be upper or lower extremity, as well as distal or proximal (to the popliteal vein)
- Incidence is ∼2 1st time VTE episodes per 1,000 person yr.
- Prevalence increases with advancing age
- Common in both medical and surgical hospitalized patients
- Diagnosis is more accurate using active surveillance rather than clinical suspicion.
DVT in children is unusual, but when cases do occur, search for an underlying reason for hypercoagulability. Also, upper-extremity DVT is associated with central IV lines in children.
- Clot formation/dissolution is an intricately balanced system which can be influenced by many factors which must be considered
- Hypercoagulable states:
- Myeloproliferative disorders
- Nephrotic syndrome
- Inflammatory conditions:
- Ulcerative colitis
- Increased estrogen:
- Exogenous hormones (OCPs, HRT)
- Antiphospholipid syndrome
- Protein S, C, and antithrombin III deficiencies, factor V Leiden, prothrombin gene mutations, lupus, others
- Prolonged bed rest
- Immobility (such as from a cast)
- Long plane, car, or train rides
- Neurologic disorders with paralysis
- Vascular concerns/damage:
- Anatomic anomalies (May–Thurner syndrome)
- Central lines:
- Especially with upper extremity DVT
- Multifactorial issues:
- Advancing age
- Medications (hydralazine, procainamide, phenothiazines)
- Tobacco use
- Prior DVT or PE
- Important with respect to some of the risk factors; ask about family history of clotting.
- There is no consensus about which patients with VTE to test for inherited thrombophilias
Pregnancy is a risk factor for DVT, especially in the 3rd trimester up to the 2nd wk postpartum.
Age in and of itself is a risk for DVT (and PE). As with many diseases, the presentation may be atypical in the elderly.