Venous thromboembolism (VTE) refers to blood clots in veins, with deep venous thrombosis (DVT) and pulmonary embolism (PE) as major life-threatening conditions. Risk factors include smoking, certain medications, obesity, surgery, and genetic disorders. Diagnosis involves physical examination and specific tests, while management focuses on anticoagulation, thrombolysis, and physical measures to prevent complications such as PE.

1. VENOUS THROMBOSIS
By
IYUMVA Aimable
BNS

2. • Venous thromboembolism(VTE) is a blood clot in
the vein.
• There is a higher chance of blood clotting in the
veins because unlike arteries, veins don’t have a
significant muscle lining and there is nothing
pumping back blood to the heart except physiology.
Therefore blood returns to the heart because the
body’s large muscles squeeze the veins as they
contract in their normal activity of moving the body.

3. • Venous thromboembolism is related to 2 life-
threatening conditions,ie;
1. Deep Venous Thrombosis(DVT)—A clot in the deep
veins located in the arm or leg.
2. Pulmonary Embolism(PE)---- A DVT clot that breaks
free from a vein wall, travels to the lungs and
blocks some or all of the blood supply.
Other types of thrombosis include;-
a) Cerebral Venous Thrombosis(CVT)
b) Portal Vein Thrombosis
c) Cavernous Sinus Thrombosis

4. Risk factors for thromboembolism
• Smoking
• Taking oestrogens or contraceptive pills
• Certain conditions eg cancer
• Autoimmune disorders eg systemic lupus
erythematosus
• Obesity
• Recent surgeries, most commonly in the hip,knee or
pelvis.
• Advancing age
• Genetic or inherited blood clotting disorders

5. Clinical presentation of venous thrombosis
• Oedema(most specific symptom)
• Leg pain
• Tenderness
• Warmth or erythema of the skin over the area
of thrombosis
• Clinical symptoms of PE as the primary
manifestation

6. Physical findings in DVT may include;-
• Calf pain on dorsiflexion of the foot(Homans
sign)
• A palpable, indurated, cordlike,tender
subcutaneous venous segment
• Variable discolouration of the lower extremity
• Blanched appearance of the leg due to
oedema(relatively rare)

7. Diagnosis
• Physical findings on patient examination
• D-dimer testing(specific proteins released
from the clot)
• Coagulation studies( eg prothrombin time and
activated partial thromboplastin time) to
evaluate for a hypercoagulable state.

8. MANAGEMENT
1. Anticoagulation( mainstay of therapy)
a) Heparins,eg Low-Molecular-Weight-
Heparin(LMWH) eg enoxaparin and also
using Unfractionated heparin(UFH)
b) Warfarin
c) Factor Xa inhibitors eg
Fondaparinux,Rivaroxaban
d) Various emerging anticoagulants

9. 2. Pharmacologic thrombolysis(for massive
clots)
3. Endovascular and surgical interventions eg
angioplasty, mechanical thrombectomy,
stenting of venous obstructions(filter placed in
the vein).
4. Physical measures eg elastic compression
stockings and ambulation.
5. Doppler studies of the affected vessel.

10. Complications of DVT
• Pulmonary Embolism
• Post phlebitic syndrome
NOTE;-
1.Diagnosis and treatment of a DVT is meant to
prevent pulmonary embolism. A DVT itself in
the leg or arm is not dangerous; it only
becomes fatal if it dislodges and moves
through the heart and lodges into one of the
pulmonary arteries.

11. 2. Blood clots in the superficial veins do not
pose a danger of causing pulmonary emboli
because the perforator vein valves(between
the superficial and deep veins) act as a sieve
to prevent clots from entering the deep
venous system. They are usually not at risk of
causing pulmonary embolism.

12. REFERENCES
• emedicine.medscape.com
• www. heart.org
• www. medicinenet.com
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