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DEFINITION:

also known asdeep venous

thrombosisoreconomy class
syndrome
Is the formation of ablood clotin a vein
that is deep inside a part of the body
Deep vein thrombosis commonly
affects thelegveins (such as the
femoral veinor thepopliteal vein) or
the deep veins of thepelvis.

PATHOPHYSIOLOGY

Thrombus
Originates as a platelet nidus in the

region of venous valves located in


the veins of the lower extremities.
Further growth occurs by accretion of
platelets and fibrin and progression
to red fibrin thrombus, which may
either break off and embolize or
result in total occlusion of the vein.

CAUSES:

Trauma- injury to the vessel wall/throbophilia


Hormones- increased coagulability
Road traffic accidents
Operations-orthopaedic surgery
Malignancy- sluggish blood flow
Blood disorders- polycythemia
Oral contraceptives/ HRT
Serious illness
Immobilisation
Splenectomy

SYMPTOMS:
There may be no symptoms referable to the

location of the DVT


But the classical symptoms of DVT include pain,
swelling and redness of the leg and dilation of the
surface veins.
Dull aching or nagging pain in the calf muscle
Low grade fever + increased PR = characteristic
Phlegmasia alba dolens refers to white leg, occurs
when thrombus extends from calf region to ileofemoral vein
Phlegmasia coerulea dolens refers to blue leg with
loss of superficial tissues of the toes, leg is usually
painful,cyanosed(blue from lack of oxygen)
andedematous(filled with fluid). Venous gangrene
may supervene.

SIGNS:
HOMANS TEST: forcible dorseflexion

of foot results in severe pain in the


calf region
MOSES TEST: tenderness over calf

muscle, on squeezing the muscle


from side to side (ideally should not
be done for fear of embolism)

WELLS CRITERIA:

DIAGNOSIS:
gold standardisintravenous

venography, which involves injecting


a peripheral vein of the affected limb
with acontrast agentand takingXrays, to reveal whether
thevenoussupply has been
obstructed. Because of its
invasiveness, this test is rarely
performed.

INVESTIGATIONS:
BLOOD TESTS:
D-DIMER
PT/APTT/INR
FBC

IMAGING:
Contrast venography as gold standard
B-mode US (compression US)
Duplex US with or without colour
Doppler

PROPHYLAXIS:
Decrease obesity
Low dose heparin 5,000 units s/c , 2

hours before surgery and 24 hours after


surgery, and then every 12 hours for 5
days, during major surgeries
Intermittent pneumatic compression of
the calf throughout the operation,
maintains the blood to lower limbs.
Inflation pressure is around 30-50mmHg
Early mobilisation.

TREATMENT:
Inject HEPARIN 10,000 units iv bolus

with continuous infusion 30,000 to


45,000 units per day.
APTT should be monitored
Heparin is given for 7-10 days
Warfarin should be started 2-3 days
before heparin is withdrawn

COMPLICATIONS:
Permanent oedema of the limb

inverted beer bottle appearance


Pulmonary embolism, because
thrombus is not attached to vessel
wall
Secondary varicosity and non healing
ulcer

Thank you

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