DVT

Etiology:

  1. Immobility (long distance traveling in airplane, taxi/bus driver,
    prolonged bed rest),
     
  2. Postoperative,
     
  3. Trauma to pelvis/LE,
     
  4. BCP (estrogen based),
     
  5. Malignancy,
     
  6. SLE,
     
  7. Pregnancy,
     
  8. Obesity,
     
  9. CHF,
     
  10. Hypercoagulability states (prot. C deficiency, APS, CA, etc.)

S & S:

  1. Pain,
     
  2. Swelling,
     
  3. Tenderness,
     
  4. "Cord" in the back of the calf, Homan's sign.

All these findings together are present only in 25-50%.. DVT can also involve UE and present itself with similar  S&S or like SVC syndrome. Risk of  PE is 15%.

DX:

  1. Doppler-detects clots like IPG but accuracy is 95%.
     
  2. D-dimers - sensitivity 90% but specificity is 30-40%
     
  3. Venogram-100% accurate.
     
  4. IPG-accurate to 80% in detecting  clots in ileofemoral system (less accurate for calf clots)
     

Differential Dx:

 Baker cyst, ruptured muscle, Achilles tendon rupture, compartment

 syndrome, cellulitis

Treatment:

  1. If Doppler and  D -dimers are (+)ve  Heparin, Elevate leg, Locale heat, Analgesics.
     
  2. Heparin dose is 5000 - 10000 U bolus followed by 25000U in 250 D5W @ 10 - 15 cc/hr or 15 U/kg/hr. The peak effect is in 20-60 min and T1/2 in 0.5-2.5 hr.
     
  3. Also enoxaparin (Lovenox®) is given in acute DVT. Dose is 1.5 mg/kg SQ qd or 1 mg/kg SQ bid x at least 5 days and start Warfarin on day 2 while continuing Lovenox® until PT is therapeutic for 5-6  consecutive days (See P.E. for details). This recommendations are as of  3/1997 - see latest for details.
     
  4. If  the Doppler and D-dimers are (-)ve ® DC pt with repeat test in 1-2 days if pt is at risk and suspicion is still present
     

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