Deep Venous Thrombosis

What is Deep Vein Thrombosis?

Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot forms in a deep vein.
These clots usually develop in the lower leg, thigh, or pelvis, but they can also occur in the arm.
It has the potential of being dislodged to the lungs, causing pulmonary embolism.

Predisposoing factors to deep vein thrombosis

  1. Old age
  2. Obesity
  3. Hyper-coagulable states
  4. Long periods of immobilization e.g. cardiac failure, following surgery, long-distance travel, etc
  5. Varicose veins
  6. Pregnancy and pueperium
  7. Malignancies

Symptoms of Deep Venous Thrombosis

  • DVT Could be asymptomatic
  • It may present with pain and swelling of the leg (calf muscles)

Differential diagnoses

  • Cellulitis
  • Infarctive crisis in sicklers
  • Abscess (pyomyositis)

Complications of Deep Venous Thrombosis

  • Pulmonary embolism

Investigations

  • Full Blood Count and differentials
  • Prothrombine time
  • KCCT
  • Doppler of the leg/pelvic vessels (veins)
  • Echocardiography
  • Electrocardiography
  • Venography (pelvic or calf veins)

Treatment for deep vein thrombosis

Treatment objectives

The following are the treatment objectives of DVT:

  1. Lyse the clot
  2. Prevent clot from being dislodged
  3. Relieve inflammation

Non-drug treatment

  • Avoid stasis

Drug treatment

Achieve APTT of 1.5 to 2.5 of control:
Heparin 5000 10,000 units by intravenous injection followed by subcutaneous injection of 15,000 units every 12 hours or intravenous
infusion at 15 – 25 units/kg/hour, with close laboratory monitoring.
Warfarin 1-5 mg orally daily for 6-12 weeks.
Maintain Target INR at 2-2.5

Notable adverse drug reactions

  • Bleeding from heparin, warfarin
  • Osteoporosis (heparin)

Prevention of deep vein thrombosis

To prevent those at risk of developing DVT from doing so, do the following:

  • Prophylactic low molecular weight heparin 5000 subcutaneously every 12 hours
  • Early mobilization