Where a blood clot forms in a deep vein usually due to pooling of that blood due to lack of movement. Rarely embolises to lungs
Causes/Factors
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Virchows triad:
- Stasis of blood
- Endothelial damage
- Hypercoagulability
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Age
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Genetic (Factor V Leiden)
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Oestrogen levels (Combined Oral Contraceptive)
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Trauma/surgery
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Cancer
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past DVT
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smoking
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Hypertension (sheering force on vessels)
Symptoms
- Swelling of right or left calf - very rare to be both
- Pain in calf
- Possible no symptoms until respiratory distress
Signs
Physical exam generally unreliable as similar to dermatitis
- Swelling and redness of leg
- Dilation of surface veins
- Pitting oedema
- Mild temperature
- Tenderness over veins when gentle pressure applied
Diagnostic Tests
- Wells Score
- D-dimer, -ve excludes DVT but +ve does not confirm
- Ultrasound of leg - shows reduced venous flow
- Thrombophilia test - before starting anticoagulant therapy
Management
- Immediate: Treatment dose apixaban or rivaroxaban or LMWH
Continue anti-coagulation (1st DOAC, Warfarin for those with Antiphospholipid syndrome, LMWH in Pregnancy) for:
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3 months if the DVT was provoked
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6 months if unprovoked or irreversible underlying cause
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Compression stockings
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Early and regular walking
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IVC filter in recurrent cases