dvt 1.pptx
TRANSCRIPT
![Page 1: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/1.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 1/52
Deep vein
thrombosis
![Page 2: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/2.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 2/52
Semisolid coagulum within fowing blood invenous system
![Page 3: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/3.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 3/52
![Page 4: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/4.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 4/52
Patient actorsAge
Obesity
Varicose veinsImmobility
Pregnancy Puerperium
High-dose oestrogen
therapyPrevious V! or P"
!hrombophilia
![Page 5: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/5.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 5/52
iseaseSurgery# !rauma
$alignancy
Heart ailure%ecent $I
Paralysis o lowerlimb
Inection
Infammatory boweldisease
&ephrotic syndrome
Polycythaemia
Paraproteinaemia
P&H'eh(et)s disease
Homocystinaemia
![Page 6: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/6.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 6/52
!hrombophiliaCongenital
e*ciency o anti-thrombin III# protein +
or protein S
Antiphospholipidantibody or lupusanticoagulant
,actor V eiden genedeect or activatedprotein + resistance
ys*brinogenaemias
Acquired
Antiphospholipidantibody or lupusanticoagulant
![Page 7: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/7.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 7/52
![Page 8: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/8.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 8/52
+linical eaturesPain and swelling o
cal
%edness
"ngorged super*cialveins
cramp in the lower
cal that persists or
several days and
becomes moreuncomortable as time
progresses.
![Page 9: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/9.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 9/52
Pittng edema
ilated veins
Sti/ cal !ender vein course
Homans sign
![Page 10: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/10.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 10/52
+linical eaturesFeatures of PE
$assive - yspnea# syncope# hypotension#
cyanosissmall - situated distally near the pleura-
pleuritic pain# cough# or hemoptysis
0classic0 signs- tachycardia# low-grade ever#
nec1 vein distention# and an accentuated P 2
![Page 11: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/11.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 11/52
Venous gangrene
![Page 12: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/12.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 12/52
%uptured ba1er)s cyst#
+al muscle haematoma# %uptured plantaris muscle#
!hrombosed popliteal aneurysm
Arterial ischemia
![Page 13: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/13.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 13/52
Diagnosis
![Page 14: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/14.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 14/52
Clinical variable Score
Active cancer 3Paralysis # paresis# recent cast 3
'edridden or4 5 days # ma6or surgery
7 32 wee1s
3
!enderness along deep veindistribution
3
"ntire leg swelling 3
8nilateral cal swelling 45 cm 3
Pitting edema 3
+ollateral super*cial non varicose veins 3
Alternate dia nosis at least li1el as -2 9: # $ 3#2 H;5
![Page 15: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/15.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 15/52
![Page 16: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/16.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 16/52
Venous 8S<3 ac1 o vein compressibility=principal>
Absence o ?win1@ on crosssection
,ailure to oppose walls dueto passive distension
![Page 17: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/17.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 17/52
2 !hrombus
homogenous # lowechogenecity
![Page 18: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/18.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 18/52
5 +al compression blunts
doppler fow signal
![Page 19: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/19.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 19/52
![Page 20: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/20.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 20/52
![Page 21: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/21.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 21/52
![Page 22: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/22.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 22/52
![Page 23: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/23.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 23/52
![Page 24: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/24.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 24/52
![Page 25: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/25.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 25/52
![Page 26: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/26.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 26/52
![Page 27: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/27.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 27/52
![Page 28: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/28.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 28/52
Management
![Page 29: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/29.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 29/52
ProphylaisLow B young# minor illness # operations
lasting 75:
Moderate B 4 C: or with a debilitating illnesswho are to undergo ma6or surgery.
igh B 3> 4C: who have seriousaccompanying medical conditions= +VA $I>#
2>ma6or surgery with an additional ris1actor =past history o venousthromboembolism or 1nown malignantdisease.>
![Page 30: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/30.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 30/52
High-ris1 general surgery-$ini-8,H or $EH
!horacic surgery- $ini-8,H FIP+
+ancer surgery - $EH#consider 3 month oprophylais
![Page 31: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/31.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 31/52
!otal hip replacement#
total 1nee replacement# hipracture - $EH#ondaparinu
![Page 32: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/32.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 32/52
&eurosurgery - IP+
&eurosurgery or brain tumor-$ini-8,H or $EH# F IP+ Fpredischarge venous
ultrasonography $edically ill patients- $ini-8,H or $EH
![Page 33: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/33.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 33/52
Anticoagulationcontraindicated - IP+
ong-haul air travel - $EHor very high-ris1 patients
![Page 34: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/34.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 34/52
!reatment G
anticoagulationInitiation G 8,H # $EH #ondaparinu
Proven HI! G direct thrombininhibitor G agatroban #
lepirudin # bivalirudin$aintenance G wararin
![Page 35: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/35.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 35/52
![Page 36: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/36.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 36/52
![Page 37: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/37.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 37/52
AP!! G 2 -5
![Page 38: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/38.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 38/52
iv bolus - :::-3:::: 8
ollowed by inusion 3:::-3::8hr
Short t J
![Page 39: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/39.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 39/52
![Page 40: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/40.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 40/52
<reater bio availability #
predictable # longer tJ"noaparin
alteparin
![Page 41: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/41.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 41/52
![Page 42: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/42.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 42/52
,ondaparinu G anti Ka
pentasaccharide&o lab monitoring no HI!
![Page 43: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/43.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 43/52
Eararin
![Page 44: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/44.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 44/52
Initiated in mg dose
!arget I&% 2. =2-5>
![Page 45: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/45.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 45/52
urationP" ater surgery# trauma#
or estrogen eposure-have a low rate orecurrence ater 5GLmonths oanticoagulation.
![Page 46: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/46.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 46/52
V! isolated to an upperetremity or cal that has been
provo1ed by surgery# trauma#estrogen# or an indwelling centralvenous catheter or pacema1er- 5
months o anticoagulationsuMces.
,or provo1ed proimal leg V!
![Page 47: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/47.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 47/52
cancer and V!"# 5GL monthso $EH as monotherapywithout wararin and tocontinue anticoagulation
inde*nitely unless the patientis rendered cancer-ree.
![Page 48: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/48.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 48/52
Idiopathic# unprovo1ed
V!"# =incl long-haul airtravel> anticoagulationor an inde*nite durationwith a target I&% between2 and 5
![Page 49: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/49.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 49/52
.moderate or high levels oanticardiolipin antibodies -inde*nite-durationanticoagulation even i the
initial V!" was provo1ed bytrauma
![Page 50: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/50.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 50/52
,ibrinolysis
rtPA
Iliac vein thrombosis
![Page 51: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/51.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 51/52
IV+ *lters
![Page 52: dvt 1.pptx](https://reader033.vdocuments.net/reader033/viewer/2022050800/577c79761a28abe05492bce5/html5/thumbnails/52.jpg)
7/26/2019 dvt 1.pptx
http://slidepdf.com/reader/full/dvt-1pptx 52/52
Active bleeding
%ecurrent venousthrombosis despiteanticoagulation