DVT (26)

DEEP VEIN THROMBOSIS (DVT)-

Definitions

Unprovoked deep vein thrombosis implies that no identifiable provoking environmental event for DVT is evident.

Proximal DVT is one that is located in the popliteal, femoral, or iliac veins.

Isolated distal DVT has no proximal component, is located below the knee, and is confined to the calf veins (peroneal, posterior, anterior tibial, and muscular veins).

TREATMENT - 

(1) MEDICAL

Anticoagulation is the mainstay of therapy.

Acute symptomatic proximal DVT - anticoagulation (Grade 1B), provided the risk of bleeding is not high.

Asymptomatic proximal DVT - anticoagulation

Symptomatic isolated distal DVT - anticoagulation

For select patients with isolated distal DVT (eg, those at high risk of bleeding, negative D-dimer level, asymptomatic or minor symptoms, without risk factors for extension, and/or minor thrombosis of the muscular veins), surveillance with serial ultrasound over a two-week period rather than anticoagulation (Grade 2C).

(2) IVC FILTER

Validated indications:-

Absolute contraindication to therapeutic anticoagulation,(Grade 2C)

Complication to anticoagulation, and

Failure of anticoagulation when there is acute proximal venous thrombosis.(recurrent embolism despite adequate anticoagulation).

(3) CATHETER DIRECTED THROMBOLYSIS IN LOWER EXTREMITY DVT

- Massive proximal lower extremity or iliofemoral thrombosis with severe symptomatic swelling or limb-threatening ischemia (ie, phlegmasia cerulea dolens [PCD])

- symptoms for less than 14 days

(provided the patient has good functional status and a low risk of bleeding).