Deep vein thrombosis (DVT), is the formation of a blood clot in a deep vein, most commonly the legs.[2][a] Symptoms may include pain, swelling, redness, or warmth of the affected area. About half of cases have no symptoms. Complications may include pulmonary embolism, as a result of detachment of a clot which travels to the lungs, and post-thrombotic syndrome.[2][3]
Risk factors include recent surgery, cancer, trauma, lack of movement, obesity, smoking, hormonal birth control, pregnancy and the period following birth, antiphospholipid syndrome, and certain genetic conditions. Genetic factors include deficiencies of antithrombin, protein C, and protein S, and factor V Leiden mutation. The underlying mechanism typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.
Deep vein thrombosis (DVT), is the formation of a blood clot in a deep vein, most commonly the legs.[2][a] Symptoms may include pain, swelling, redness, or warmth of the affected area. About half of cases have no symptoms. Complications may include pulmonary embolism, as a result of detachment of a clot which travels to the lungs, and post-thrombotic syndrome.[2][3]
Risk factors include recent surgery, cancer, trauma, lack of movement, obesity, smoking, hormonal birth control, pregnancy and the period following birth, antiphospholipid syndrome, and certain genetic conditions. Genetic factors include deficiencies of antithrombin, protein C, and protein S, and factor V Leiden mutation. The underlying mechanism typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
anatomy of the lower extremity veins, CVI , ambulatory venous hypertension, varicose veins , clinical examination and performance of various tests of the varicose veins
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
It is estimated that 20% of American women and 7% of American men suffer from venous disease. Venous disease results in symptoms such as aching, fatigue, swelling, and pain in the legs which can interfere with daily living.Cosmetic issues may affect quality of life.
At least 20% of patients with venous disease will develop leg ulcers. This presentation outlines the normal anatomy and physiology of venous drainage of the extremities as well as the common venous disorders such as varicose veins and deep vein thrombosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Acute Deep Venous
Thrombosis: Clinical and
Diagnostic Evaluation
by
Mohammed Salah
Ass .lecturer –vas .surgery department
2. Introduction
DVT is one of the most significant public health
problems.
Economic impact is very huge .
Early diagnosis of acute DVT is necessary for
achieving the best outcomes
3. Introduction
detection of this disease is challenging as its early
stages are frequently subclinical.
To address this challenge, strategies have been
developed that include risk assessment as the first
diagnostic step.
Adaptation of these strategy make clinical diagnosis
of acute DVT is more accurate .
4. Cost -effectiveness
producing optimum results for the expenditure.
continuous shift toward early treatment of the
majority of the patients based on the clinical
information, reserving more expensive diagnostic
tests for patients who require invasive treatment.
6. Clinical picture
The clinical manifestations of acute DVT varies
greatly.
About 50% of cases may be asymptomatic.
Broad variation is a result of multiple pathologic
processes
7. Such pathological processes include
1.Timing of presentation …… severity
2.Anatomic distribution……degree of occlusion
3.Functional state of lymphatic system
4. preexisting venous and lymphatic insufficiency
all these factors lead to varieties in C/P from mild edema
to phlegmasia cerulae or venous gangrene.
8. Signs and symptoms
Common symptoms of DVT include:
Leg pain and tenderness
Oedema (swelling)
Redness
9. C/P
The most common symptoms and signs of DVT are dull
ache or pain in the leg, tenderness, swelling, erythema,
cyanosis, and fever.
Edema, cyanosis, and pain are features of phlegmasia
cerulea
Venous gangrene is a rare condition that occurs usually
in patients with cancer, can occur with heparin-induced
thrombocytopenia with thrombosis, and is generally
associated with warfarin-mediated protein C depletion
11. C/P
The most common symptom of calf pain variable
sensitivity and specificity due to high prevalence of
the same signs and symptoms in patients without
DVT.
Withholding treatment on the basis of clinical
evaluation in primary care settings leads to
inadequate management of more than 10% of
patients with DVT.
High variability and lack of specificity limit the role of
clinical examination in patients with suspected DVT
12. Signs and Symptoms of
DVT’s
Recognize and report
signs/symptoms of a DVT
including:
Unilateral edema
Erythema
Calf tenderness
Pale leg & cool with diminished
arterial pulse
13. Pratt's test: Squeezing of posterior calf elicits pain.
Homan’s sign (discomfort in the calf muscles on
forced foot dorsiflexion w/ knee straight; NOTE:
Homan’s sign is neither sensitive nor specific;
Present in <1/3 of patients with confirmed DVT;
Found in >50% of patients without DVT) (Schreiber,
2009)
15. D-dimers: what is the role?
D-dimer is a product of fibrin proteolysis by
plasmin; therefore, its elevated levels signify
that fibrinolysis of complexed fibrin is taking
place
In other words D-dimer: degradation product
of cross-linked fibrin
The appeal: a simple blood test .
16. D-dimers
The concentration of D-dimer in plasma has become
a widely used marker for the diagnosis of DVT its
elevated levels signify that fibrinolysis of complexed
fibrin is taking place.
High sensitivity, low specificity
• Quantitative D-dimer < 500 ng/ml makes PE less
likely.
17. D-dimers
Elevated d-dimer common w/o clot - especially as
part of the response to injury
1.Pathological as surgery patient , Trauma
Cancer patient ,patient with thrombotic disorders
2.Physiological as pregnancy
18. D-dimers
The degree of D-dimer elevation in patients with
DVT varies with the size and extent of the thrombus,
the time from its onset, and the use of
anticoagulation.
Different types for assay most accurate one for DVT
is ELISA but most laborious and slow. Rapid point
of- care assays are probably the most practical as
the results are obtainable within minutes and their
sensitivity is comparable to that of the enzyme-
linked immunosorbent assay
19. D-dimers
concentration of D-dimer below the cutoff value
indicates a very low probability of DVT, it does not
exclude it with sufficient accuracy, especially in
cases of distal thrombi, use of anticoagulation, or
long duration between the onset of thrombosis and
testing
Similar to clinical evaluation, the use of D-dimer as a
single diagnostic tool may result in inadequate
management of more than 15% of patients with
suspected DVT.
20. Duplex ultrasonography
Duplex ultrasonography remains the dominant
diagnostic test of choice for the detection of DVT.
accuracy, lack of radiation, portability,
noninvasiveness, and relative cost-effectiveness. In
addition, ultrasound has the ability to distinguish
among nonvascular pathologic processes, such as
inguinal adenopathy, Baker’s cyst, abscess, and
hematoma
21. Pitfalls of Duplex
Misidentification of veins
missing of duplicate venous systems;
systemic illness or hypovolemia resulting in decreased venous
distention
suboptimal imaging in obese or edematous patients; and
areas not amenable to compression, such as the iliac veins,
the femoral vein at the adductor canal, and the subclavian
veins.
As with most ultrasound-based imaging studies, the quality of
the examination depends on the skill of the technologist
performing the study.
22. diagnostic criteria for DVT
in Duplex
Duplex ultrasound diagnostic criteria for DVT
1.increased intraluminal echogenicity,
2. increased venous diameter,
3.inability of the vein to collapse under a moderate
pressure from the transducer,
4.absence of spontaneous blood flow,
5. and absence of flow augmentation with distal
compression
24. diagnostic criteria for DVT
in Duplex
Among these factors, inability to compress the vein
is the most widely used objective criterion for the
diagnosis of DVT.
limitation of compression ultrasound is its lack of
accuracy in the evaluation of calf veins
evaluation of venous flow with color Doppler and
spectral Doppler can improve the accuracy of
compression ultrasonography
25.
26. Plethysmography
Plethysmography is a noninvasive method of
estimating changes in volume in an extremity.
Because all other tissues maintain constant volume
during the short period of testing, any recorded
volumetric differences reflect changes in blood
volume.
27. Plethysmography
Several plethysmographic techniques with different
sensors have been used to measure changes in blood
volume
strain-gauge plethysmography (SGP) primarily been
used in the past for the diagnosis of deep venous
thrombosis(DVT),
impedance plethysmography (IPG),
Photoplethysmography (PPG),
and air plethysmography (APG).
28. Plethysmography
assess thrombus resolution and recanalization.
Because the occlusive cuff is placed on the thigh,
plethysmographic diagnosis of calf DVT is especially
problematic.
29. Limitation of Plethysmography
Successful recordings from SGP require full cooperation
from the patient.
It cannot be performed on patients;
who are unable to lie flat. Prolonged recumbency, muscle
wasting, and cardiac failure may result in measurement
errors.
Patients with limb injuries, bandages, casts, or severe
edema
are unsuitable candidates for SPG
30. CT VENOGRAPHY
Computed tomographic arteriography is an excellent
technique for the diagnosis of pulmonary embolism.
(CTV), has yet to gain traction for the diagnosis of
acute DVT in the lower or upper extremities.
The diagnostic capabilities of CTV are remarkable in
the thigh and pelvis compared with duplex
ultrasound
31. CT VENOGRAPHY
In addition, when CTV is used in conjunction for
evaluation of PE, it adds only 3 to 5 minutes to the
examination, making it an attractive option as the
sole diagnostic modality for acute lower extremity
DVT
CTV has not been well studied for acute calf vein
less cost-effective than duplex ultrasound.
involves the use of contrast material, and it uses
radiation
33. Advantages of MRV
MRV is less expensive than contrast venography but
more expensive and less operator dependent than
duplex ultrasound.
Non–contrast-enhanced techniques include time-of-
flight imaging.
Contrast enhanced MRV. such gadolinium.
34. MRV
MRV used to diagnose acute DVT in larger venous
segments, but less sensitivities when smaller
diameter veins are evaluated.
vessel wall enhancement can be visualized with
acute thrombus, allowing the examiner a crude
detection of thrombus age
35. Disadvantages of MRV
demands a nonmoving patient and long imaging
times that, when paired, can be a significant hurdle.
The below-knee segments of venous anatomy are
often paired, accounting for significant artifact during
post processing of the images
gadolinium can be toxic in patients with renal
dysfunction
36. Conclusion
MRV
MRV can be preserved for detection of thrombus in
centrally located venous structures not always
accessible to duplex ultrasonography.
MRV useful for detection of hypogastric venous
thrombosis
a remarkable 27% of patients without a detectable
source of thrombus by duplex ultrasound who have
sustained a PE had thrombus identified by MRV.
37. Contrast venography
Contrast venography for the sole purpose of diagnosing DVT is
largely of historical interest.
It is expensive and inconvenient compared with other
diagnostic modalities and potentially causes patient discomfort.
Complications of the examination include nephrotoxicity,allergy,
phlebitis, and the need for intravenous access.
Nevertheless, contrast venography can be useful when other
studies have not produced a solid diagnosis, making it
important to retain this technology for diagnosis and
therapeutics.
38. Contrast venography
The Rabinov-Paulin technique uses spot film, and
the long-leg technique uses cine film.
contrast venography should be used as the “golden
backup” when the diagnosis of acute DVT remains
in question after a venous duplex examination
40. 18F-FDG
18F-labeled fluorodeoxyglucose positron emission
tomography/computed tomography (18F-FDG
PET/CT) .18F-FDG is a glucose analogue that is
actively and avidly absorbed by tissues and cells
with rapid metabolism. Among these are tumor cells,
endothelial cells, macrophages, and lymphocytes
41. 18F-FDG PET/CT
18F-labeled fluorodeoxyglucose positron emission
tomography/computed tomography (18F-FDG
PET/CT) has been shown to:
detect acute DVT, to determine thrombus age.
differentiate acute thrombus from tumor thrombus.
43. DIAGNOSTIC STRATEGIES
In the absence of a single reliable, accurate, and
inexpensive diagnostic test, stratification of patients
based on their risk of DVT substantially enhances clinical
decision making.
strategies have been developed that include risk
assessment as the first diagnostic step.
The result is a continuous shift toward early treatment of
the majority of the patients based on the clinical
information, reserving more expensive diagnostic tests
for patients who require invasive treatment.
44. Two-level DVT Wells score
Clinical feature Points
Active cancer (treatment ongoing, within 6 months, or palliative) 1
Paralysis, paresis or recent plaster immobilisation of the lower
extremities
1
Recently bedridden for 3 days or more or major surgery within
12 weeks requiring general or regional anaesthesia
1
Localised tenderness along the distribution of the deep
venous system
1
Entire leg swollen 1
Calf swelling at least 3 cm larger than asymptomatic side 1
Pitting oedema confined to the symptomatic leg 1
Collateral superficial veins (non-varicose) 1
Previously documented DVT 1
An alternative diagnosis is at least as likely as DVT −2
Clinical probability simplified score
DVT likely 2 points or more
DVT unlikely 1 point or less
a Adapted with permission from Wells PS et al. (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein
thrombosis. New England Journal of Medicine 349: 1227–35
45. DIAGNOSTIC STRATEGIES
It is increasingly recognized that the optimal
approach to DVT diagnosis includes risk
stratification based on the Wells score and D-dimer
assay, followed by diagnostic testing in high-risk
patients and in patients who require advanced
treatment modalities.
In low and intermediate risk patients, the
combination of a Wells score and negative D-dimer
result reaches a negative predictive value
approaching 100%.
46.
47. DIAGNOSTIC STRATEGIES
Evaluation of patients with a high probability of DVT
is more problematic. Negative D-dimer results in
these patients are associated with PE rates of up to
15%.
So, treatment should be started before additional
testing is completed. When anticoagulation is
initiated, delay in definitive diagnostic studies has
been shown to be safe.
48.
49. DVT during pregnancy
The risk of bleeding complications limits the use of
anticoagulation to cases with confirmed DVT.
D-dimer levels have been known to increase during
the course of a normal pregnancy and are of
unproven utility during pregnancy.
For these reasons, ultrasound remains the preferred
diagnostic test for detection of DVT in pregnancy.
50. Thrombophilia screening
Factor V leiden, Prot C/S deficiency
Antithrombin III deficiency
• Idiopathic DVT < 50 years
• Family history of DVT
• Thrombosis in an unusual site
• Recurrent DVT
51. Patient with suspect symptomatic
Acute lower extremity DVT
Venous duplex scan negative Low clinical probability observe
High clinical probability
Repeat scan /
Venography
negativepositive
Evaluate coagulogram /thrombophilia/ malignancy
Anticoagulant therapy
contraindication
yes IVC filter
No
pregnancy LMWH
OPD LMWH
hospitalisation UFH
+ warfarin
Compression treatment