a brief about DVT

1. DEEP VEIN THROMBOSIS
Dr. Md Abdul
Halim

2.  Deep vein thrombosis (DVT) is a blood
clot (thrombus) that forms in a deep
vein, usually in the legs .
 A calf vein is the common site for a
DVT. A thigh vein is less commonly
affected.
 The annual global incidence is 1.6 per
1000.
Introduction

5.  The deep veins that lie near the center of
the leg are surrounded by powerful muscles
that contract and force deoxygenated
blood back to the lungs and heart.
 One-way valves prevent the back-flow of
blood between the contractions.
 When the circulation of the blood slows
down due to illness, injury or inactivity, blood
can accumulate or “pool,” which provides
an ideal setting for clot formation.
 One in every 100 people who develops
DVT dies.
Deep Vein Thrombosis Facts

7. Risk Factors

8.  Recently, it has been referred
to as “Economy Class
Syndrome” due to the
occurrence after sitting on long
flights & `e-thrombosis` as blood
clots occuring in people sitting
at their computers for long
periods of time.
Risk Factors

9.  Calf or leg pain or tenderness
 Swelling of the leg or lower
limb
 Varying degrees of redness
 Warm skin
 Cellulitic Leg- white or,
cyanosed
 Signs of pulmonary embolism
Only about 50% of people experience
symptoms when they have DVT.
Symptoms

10. Diagnosis
 Clinical symptoms and signs are non specific
 D-dimer test demonstrates the presence of blood clot
degradation products
 Modified Wells Criteria for predicting pulmonary embolism
 A score <4 means pulmonary embolism is unlikely
 A score >4 suggestive of pulmonary embolism

11. Modified Wells criteria

12.  Duplex Ultrasound is the
current standard imaging
technique.
 Acending venography now
rarely required
 MR venography
 CT Scan of pulmonary
arteries- for PE
Investigations

13.  Ruptured Baker’s cyst
 Calf muscle Haematoma
 Ruptured plantaris muscle
 Thrombosed popliteal aneurysm
 Arterial ischemia
Differential Diagnosis

14. When a blood clot forms in a leg
vein it usually remains stuck to the
vein wall.
The symptoms tend to settle
gradually.
But, there are possible
complications:
 Pulmonary embolism
 Venous ulcer disease
 Post thrombotic syndrome
Complications

15. Management falls into two broad groups:
• Treatment of established DVT.
• Prophylaxis
Management

16. Treatment of established DVT
The Goals of treatment is three-fold:
• Acute Phase - stabilize the thrombus & prevent PE
• Intermediate Phase - prevent recurrent VTE &
complications.
• Long term - Maintenance
Management

17. General measures include:
• Adequate hydration
• Initial bed rest
• Aggressive treatment / care of underlying factors
Management

18. Specific treatment options are:
 Anticoagulation
 Thrombolysis
 Inferior venacava filter
A very few surgeon perform Mechanical Thrombectomy
Indication-
•Threatened venous gangrene
•Phlegmasia cerulia dolens
Management

19. Anticoagulation
Low molecular weight heparin
Warfarin
Unfractionated Heparin
Tissue plasmiogen activator (more usually urokinase
in US)- for thrombolysis
Management

20. Caval filter
Indications for insertion
Pulmonary embolism with
contraindication to
anticoagulation
Recurrent pulmonary embolism
despite adequate anticoagulation
Caval filter in the IVC
Management

21. Prophylaxis

22. DVT prophylaxis
Pharmacological prophylaxis reduces the
incidence of fatal pulmonary embolism by 50%.
Prophylaxis can be either:
• Mechanical
• Pharmacological
Prophylaxis

23. Mechanical
Mechanical methods include
• graduated elastic compression stockings and
• intermittent pneumatic compression devices.
Mechanical methods may also be combined with
pharmacological methods.
Pharmacological
•Low molecular weight heparins - given subcutaneously in a
once-daily dose.
•Unfractionated Heparin and oral anticoagulants are now
rarely used

26.  DVT- an under-diagnosed threat
 Patients presented with sudden swelling, redness,
and pain in the calf or leg- DVT is a suspicion
 Without proper and timely treatment- can lead
to serious, life threatening complications
 Anticoagulation protects against pulmonary
embolism
 Identification of Risk groups and prophylaxis can
reduce mortality and morbidity
Conclusion

27. THANK
YOU