24/11/2023
1. **Definition:**
- DVT refers to the formation of a blood clot (thrombus) in one of the deep veins, usually in the legs.
2. **Risk Factors:**
- **Virchow's Triad:** DVT is often associated with factors contributing to venous stasis, endothelial injury, and hypercoagulability.
- **Surgery or Trauma:** Major surgeries, especially orthopedic procedures, and trauma increase the risk.
- **Immobility:** Prolonged periods of immobility, such as during long flights or bed rest.
- **Cancer:** Particularly certain malignancies.
- **Obesity, Smoking, Age:** These are additional risk factors.
3. **Clinical Presentation:**
- **Swelling and Pain:** Most commonly in the calf.
- **Warmth and Erythema:** The affected area may be warm to the touch with redness.
- **Homan's Sign:** Calf pain with dorsiflexion of the foot, but this sign is not very specific and not commonly used in clinical practice.
4. **Complications:**
- **Pulmonary Embolism (PE):** DVT can lead to a life-threatening PE if the clot dislodges and travels to the lungs.
- **Post-Thrombotic Syndrome:** Chronic pain, swelling, and discoloration of the affected limb.
5. **Diagnostic Studies:**
- **Doppler Ultrasound:** The primary imaging modality for diagnosing DVT.
- **D-Dimer Test:** Elevated levels can indicate the presence of clotting, but it is not specific for DVT and can be elevated in various conditions.
6. **Management:**
- **Anticoagulation:** Heparin (or low molecular weight heparin) followed by warfarin or direct oral anticoagulants (DOACs).
- **Compression Stockings:** Used to reduce swelling and the risk of post-thrombotic syndrome.
- **Inferior Vena Cava (IVC) Filter:** In cases where anticoagulation is contraindicated, a filter may be placed to prevent PE.
7. **Prevention:**
- **Prophylaxis:** In hospitalized patients, especially those undergoing surgery, prophylactic measures such as heparin or mechanical methods (compression stockings, intermittent pneumatic compression) are often used.
