Deep Vein Thrombosis

Deep Vein Thrombosis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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.

Pediatric Considerations
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.

Etiology

  • Clot formation/dissolution is an intricately balanced system which can be influenced by many factors which must be considered
  • Hypercoagulable states:
    • Cancer
    • Myeloproliferative disorders
    • Nephrotic syndrome
    • Sepsis
    • Inflammatory conditions:
      • Ulcerative colitis
    • Increased estrogen:
      • Pregnancy
      • Exogenous hormones (OCPs, HRT)
    • Antiphospholipid syndrome
    • Protein S, C, and antithrombin III deficiencies, factor V Leiden, prothrombin gene mutations, lupus, others
  • Stasis:
    • Prolonged bed rest
    • Immobility (such as from a cast)
    • Long plane, car, or train rides
    • Neurologic disorders with paralysis
    • CHF
    • Obesity
  • Vascular concerns/damage:
    • Trauma
    • Surgery
    • 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
  • Genetics:
    • 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 Considerations
Pregnancy is a risk factor for DVT, especially in the 3rd trimester up to the 2nd wk postpartum.


Geriatric Considerations
Age in and of itself is a risk for DVT (and PE). As with many diseases, the presentation may be atypical in the elderly.

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Citation

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TY - ELEC T1 - Deep Vein Thrombosis ID - 307400 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307400/all/Deep_Vein_Thrombosis ER -