DVT – Wells Score Probability High (≥ 3), Moderate (1-2) or Low (0 or less) Collateral superficial veins Localized tenderness Pitting edema greater than unaffected leg Bedrest > 3 d or surgery in past 4 wks Calf > 3cm larger than unaffected leg Paralysis or plaster immobilization Entire leg swollen Cancer
Score of 2 or higher - deep vein thrombosis is likely. Consider imaging the leg veins. Score of less than 2 - deep vein thrombosis is unlikely.Consider blood test such as d-dimer test to further rule out deep vein thrombosis.
Venography– Gold standard investigation: with pedal vein cannulation, intravenous contrast injection, and serial limb radiographs. Identification of venous filling defects is diagnostic for venous thrombosis. However, the invasive nature and significant consumption of resources are only 2 of its many limitations.
Venous duplex ultrasound—investigation of choice . Non-invasive nature, wide availability, sensitivity/specificity of 97% and 94%. However, duplex is limited by operator experience and body habitus.
D-dimers are degradation products of cross-linked fibrin by plasmin that are detected by diagnostic assays. Highly sensitive, up to 97%, not specific (35%). Many other clinical situations can result in elevated D-dimer levels, including infection, trauma, postoperative states, and malignancy
Intermittent pneumatic leg compression devices work by effectively increasing venous blood flow and activating the fibrinolytic system.
Subcutaneous heparin of 5000 units given twice daily has been shown to not only decrease the incidence of deep venous thromboses (DVTs) but also prevents fatal PE
warfarin in high-risk patients. Therapy is initiated the night prior to surgery; the anticoagulation effects of warfarin do not begin until the third day of use, preventing postoperative bleeding complications
Low-molecular weight heparin (LMWH) has been shown to be superior to both heparin and warfarin in high-risk patients such as those suffering from multitrauma and postorthopedic surgery
Enoxaparin 1mg/kg sq every 12 hours for 5 days
Warfarin started day 1 at 5 mg a day
Warfarin continued to keep INR at 2.5
(2.0-3.0 range) for 3 months
Dyspnea, pleuritic pain and cough most
common symptoms. Tachypnea, rales and
Tachycardia most common signs
Post venous thrombotic syndrome--- pain, swelling, skin changes due to destruction of veins