Javed Iqbal    FCPS, FRCSProfessor Of SurgeryQuaid-e-Azam Medical College, Bahawalpur
Deep vein thrombosis
It is a serious disease   Sudden death   Long term morbidity    • Chronic venous insufficiency    • Ulceration
Its incidence is   underestimated10% of all hospitalized deaths    are due to DVT/PE
Virchow’s triad   Change in vessel wall    • Injury    • Inflammation   Stagnation    • Hospitalized patients   Increas...
Thrombophillia   Anti-thrombin III deficiency   Protein C and S deficiency   Anti-phospholipid antibodies   Dysfibroge...
Predisposing factors/situations   Old age   prolonged surgical procedures   Procedures on Hip and pelvis   Spleenectom...
   Myocardial Infarction / CCF   Oral contraceptives / steroids   Obesity   Varicose veins   Pregnancy   malignancy
Air Travel   Immobility   Hypoxia   Decreased cabin pressure             10 % of all passengers                 of long...
E-thrombosis
What to do?
Don’t let it happen     Prophylaxis
Every unit must have itsown DVT prophylaxis policy      According to local       circumstances
The most important point is to keep in mind that DVT        does exist
The standard guideline is to define and identify the risk          groups
Low Risk   Young patients with minor ailment    having no risk factor and undergoing    a procedure of less than an hour
Moderate risk   Patient over 40 with debilitating    illness   Patient above 40 undergoing major    surgical procedure ...
High Risk   Patient over 40   Serious medical illness   Major surgery   Additional risk factor
Principals of Prevention
1        Minimizing the    correctable risk factors
2    Mechanical measures
   Graduated compression dressing    (TEDS)   Sequential pneumatic compression   Early ambulation
3    Pharmacological      intervention
   Low dose (sub-cut) heparin : 5000    units bid   Low molecular weight heparin
All moderate and high riskpatients must have some     DVT prophylaxis
If DVT does occur!
Symptoms/signs/labs   Leg pain   Swelling   Redness   Fever   Increased TLC
D-Dimer
Doppler studies
55% of DVT is in pelvic        veins
Treatment   Anticoagulation: Hepranization   Elevation of limb   Monitering
Pulmonary embolism
Massive embolism  Massive embolism
Medium vessel  embolism
Small vessel embolism
   Dyspnoea   Cough   Haemoptysis   Hypoxia   Acute right shift on ECG   X-ray chest
Management   Hepranization   Standard resuscitation   Antibiotics   Long term anticoagulation
Thank you
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Dvt

  1. 1. Javed Iqbal FCPS, FRCSProfessor Of SurgeryQuaid-e-Azam Medical College, Bahawalpur
  2. 2. Deep vein thrombosis
  3. 3. It is a serious disease Sudden death Long term morbidity • Chronic venous insufficiency • Ulceration
  4. 4. Its incidence is underestimated10% of all hospitalized deaths are due to DVT/PE
  5. 5. Virchow’s triad Change in vessel wall • Injury • Inflammation Stagnation • Hospitalized patients Increased coagubility • Surgery • Malignancy • Thrombophilia
  6. 6. Thrombophillia Anti-thrombin III deficiency Protein C and S deficiency Anti-phospholipid antibodies Dysfibrogenaemia
  7. 7. Predisposing factors/situations Old age prolonged surgical procedures Procedures on Hip and pelvis Spleenectomy Gyaenacological procedures Stroke / and other neurological ailments
  8. 8.  Myocardial Infarction / CCF Oral contraceptives / steroids Obesity Varicose veins Pregnancy malignancy
  9. 9. Air Travel Immobility Hypoxia Decreased cabin pressure 10 % of all passengers of long flights
  10. 10. E-thrombosis
  11. 11. What to do?
  12. 12. Don’t let it happen Prophylaxis
  13. 13. Every unit must have itsown DVT prophylaxis policy According to local circumstances
  14. 14. The most important point is to keep in mind that DVT does exist
  15. 15. The standard guideline is to define and identify the risk groups
  16. 16. Low Risk Young patients with minor ailment having no risk factor and undergoing a procedure of less than an hour
  17. 17. Moderate risk Patient over 40 with debilitating illness Patient above 40 undergoing major surgical procedure But there is no risk factor
  18. 18. High Risk Patient over 40 Serious medical illness Major surgery Additional risk factor
  19. 19. Principals of Prevention
  20. 20. 1 Minimizing the correctable risk factors
  21. 21. 2 Mechanical measures
  22. 22.  Graduated compression dressing (TEDS) Sequential pneumatic compression Early ambulation
  23. 23. 3 Pharmacological intervention
  24. 24.  Low dose (sub-cut) heparin : 5000 units bid Low molecular weight heparin
  25. 25. All moderate and high riskpatients must have some DVT prophylaxis
  26. 26. If DVT does occur!
  27. 27. Symptoms/signs/labs Leg pain Swelling Redness Fever Increased TLC
  28. 28. D-Dimer
  29. 29. Doppler studies
  30. 30. 55% of DVT is in pelvic veins
  31. 31. Treatment Anticoagulation: Hepranization Elevation of limb Monitering
  32. 32. Pulmonary embolism
  33. 33. Massive embolism Massive embolism
  34. 34. Medium vessel embolism
  35. 35. Small vessel embolism
  36. 36.  Dyspnoea Cough Haemoptysis Hypoxia Acute right shift on ECG X-ray chest
  37. 37. Management Hepranization Standard resuscitation Antibiotics Long term anticoagulation
  38. 38. Thank you

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