Deep Vein Thrombosis

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Deep Vein Thrombosis

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

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