Presentation :
Pathophysiology :
Diagnostics :
- Lower extremity DVT is considered proximal if the popliteal, femoral, or iliac veins are involved and is considered distal if only the calf veins (peroneal, posterior, and anterior tibial) are involved
- #todo get sensitivity and specificities for various types of studies
Treatment :
- Anticoagulation:
- All proximal LE DVT
- 3-6 mo if provoked (and provoking factor reversible)
- Otherwise indefinite
- Distal LE DVT for 3-6mo if severe sx or risk of extension (positive D-dimer, history of VTE, extensive thrombosis, >5 cm clot)
- UE DVT for 3 months or until central line removal
- 2/3 of cases are associated with central line
- Thrombolysis
- For acute DVT, thrombolysis is indicated in patients with massive thrombus leading to impaired venous drainage, severe edema, and acute limb ischemia
- The 2021 CHEST guidelines suggest aspirin in patients with an unprovoked proximal DVT or PE who are stopping anticoagulation therapy; however, continued anticoagulation is preferred.
Prognosis:
- Approximately 25% to 40% of patients with symptomatic DVT develop aspects of postthrombotic syndrome and chronic venous insufficiency, which often develop within 2 years of VTE.
- Symptoms of postthrombotic syndrome include pain, heaviness, swelling, stasis dermatitis, and ulceration in the affected limb. Treatment includes leg exercises, avoiding dependent positions for lengthy periods, and using compression stockings.