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Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
Deep Vein Thrombosis
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Deep Vein Thrombosis

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  • 1. Deep Vein Thrombosis (DVT)
  • 2. Deep Vein Thrombosis (DVT)
    • DVT: Blood clot in a vein located deep in the muscles of
    • the legs, thighs, pelvis or arms
    • DVT is the result of 3 principle factors
    • 1. Reduce or stagnant blood flow in deep veins
    • 2. Injury to the blood vessels wall
    • 3. Increase clotting activity (hyper-coagulability
    • or thrombophilia)
  • 3. Risk of DVT
    • Immobilization: prolong sitting, bed rest
    • Recent surgery or trauma: especially hip, knee or
    • gynecological surgery, fracture, childbirth
    • The use of medication: estrogen, birth control pills, tamoxifen
    • Inherited or acquired hypercoagulability,
    • Hx. of polycythemia vera, malignant tumor
    • Note : Approximately 75-90% of DVT have at least one established
    • risk factor
    • : Inherited thrombophilias can be identified in 24-37%
    • of patients
  • 4. Sign and Symptoms
    • Leg pain or tenderness
    • Leg swelling
    • Increase wormth of one leg,change in skin color (redness)
    • Homans sign positive
    • Note: these can occur in other conditions:
    • musculoskeletal injuries, cellulitis
  • 5. Investigation:
    • Doppler (Duplex) ultrasonography
    • Helical CT venography
    • Contrast venography
    • MRI
    • Blood test
      • D-dimer testing
      • For hypercoagulability:
          • antithrombin III, protein C, protein S, antithrombin, plasminogen
          • Footer V leiden mutation,
    • prothrombin G2021OA mutation,
    • hyperhomocysteinemia
          • Antiphospholipid antibodies
  • 6. Treatment:
    • To prevent PE and another DVT
        • Anticoagulant: heparin, warfarin (Coumadin)
        • to keep INR between 2-3 , duration vary from
        • 3 month to life long
        • Thrombolytic drugs: streptokinase,
    • alteplase (Activase)
        • Inferior vena cava filter
        • Surgery: Embolectomy
  • 7. Prevention:
    • Mobilization
    • Drug: LMW Heparin, Warfarin
    • Graduated compression stocking or pneumatic
    • compression stockings
    Complication and prognosis:
    • Most disappear without difficulty
    • Pulmonary embolism (up to 30% of DVT) and PHT
    • Post-phlebitic syndrome ( 25-50%):
    • chronic pain, swelling, pigmentation in the leg,
    • almost always occur within the first 2 yrs
  • 8. Buerger’s disease (thromboangritis obliterans)
    • First reported by buerger in 1908 , who described
    • the characteristic pathologic findings of acute
    • inflammation and thrombosis of arteries and veins,
    • affected hands and feet
    • Most common in young male ( 20-40 yrs)
    • who is a heavy smoker
    • More recently a higher percentage of men and women
    • over 50 yrs old have been recognized
    • Most common in Orient, SEA, India, Middle East
  • 9. Classic symptoms and signs
    • Claudicaiton or pain at rest
    • Numbness or tingling in the limbs
    • Raynaud’s phenomenon
    • Skin ulceration and gangrene of the digits
    Ulcer and gangrene of digits Angiogram demonstrating lack of blood flow to VV. of the hand
  • 10. causes
    • Association with tabacco use
    • It has been postulated that it is an autoimmune
    • reaction triggered by some constituent of
    • tabacco
  • 11. Diagnosis
    • History and physical finding
    • Doppler ultrasound
    • Angiograms of upper and lower extrimities:
    • diagnostic angiographic findings are “corkscrew”
    • appearance of arteries and or occlusions or
    • stenosis in multiple area of both arms and legs
    • Skin biopsies: rarely performed
  • 12. Differential Diagnosis
    • Atherosclerosis
    • Endocarditis
    • Other types of vasculitis
    • Severe Raynaud’s phenomenon associated with
    • connective tissue disorder: SLE, scleroderma
    • Clotting disorder of blood
  • 13. Treatment
    • Stop smoking immediately and completely
    • Antiinflammatory agents (steroid) or anticoagulation
    • (aspirin, worfarin) have not proven effective

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