2 deep vein thrombosis
TRANSCRIPT
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Deep vein thrombosis
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Color duplex scan of DVT
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Venogram shows DVT
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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 therapycontraindication
yes IVC filter
No
pregnancy LMWH
OPD LMWH
hospitalisation UFH+ warfarin
Compression treatment
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Thrombophilia screeningFactor V leiden, Prot C/S deficiency
Antithrombin III deficiency
• Idiopathic DVT < 50 years• Family history of DVT• Thrombosis in an unusual site• Recurrent DVT
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Recommendation for duration of warfarin
• 3-6 months first DVT with reversible risk factors
• At least 6 months for first idiopathic DVT• 12 months to lifelong for recurrent DVT or
first DVT with irreversible risk factorsmalignancy or thrombophilic state
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Diagram 6
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Phlegmasia cerulea dolens Venous gangrene
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Catheter directed-thrombolysis
• Consider in: Acute< 10 days iliofemoral DVT.
• Long-term benefit in preventing post-phebitic syndrome is unknown.