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Deep vein thrombosis

Definition
  • Deep Vein Thrombosis: Formation of a blood clot (thrombus) in the deep venous system, commonly in the lower extremities.
Etiology/Risk Factors
  • Virchow’s triad: Stasis of blood flow, endothelial injury, and hypercoagulability.
  • Medical conditions: Cancer, heart failure, inflammatory disorders.
  • Surgery: Especially orthopaedic, pelvic, or abdominal surgery.
  • Immobility: Long-haul flights, bed rest.
  • Meds/Therapies: Oral contraceptives, hormone replacement therapy.
  • Others: Trauma, pregnancy, family history, obesity, thrombophilia.
Pathophysiology
  • Disruption of blood flow β†’ accumulation of clotting factors β†’ thrombus formation β†’ potential embolisation.
Clinical Features
  • Local: Unilateral leg swelling, pain, tenderness, erythema, palpable cord.
  • Systemic: Fever.
  • Many DVTs can be asymptomatic.
Investigations
  • D-dimer: Sensitive but not specific.
  • Ultrasound: First-line imaging modality.
  • Venography: Gold standard but rarely used.
Management
  • Anticoagulation: Low molecular weight heparin (LMWH), warfarin, direct oral anticoagulants (DOACs).
  • Thrombolysis: In select cases.
  • Compression stockings: To reduce the risk of post-thrombotic syndrome.
  • Inferior vena cava filter: For those who can’t receive anticoagulation.
Complications
  • Pulmonary embolism (PE): Life-threatening complication.
  • Post-thrombotic syndrome.
  • Bleeding (from anticoagulation).
Key Points
  • High clinical suspicion is vital, as many DVTs may be asymptomatic or present subtly.
  • Anticoagulation is the mainstay of treatment.
  • Consider PE in any patient with a confirmed or suspected DVT, especially if they exhibit respiratory symptoms.

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