Deep Vein Thrombosis

Emergency Medicine

Thrombus in deep vein, usually lower limb.

Risk factors

  • Virchow triad: stasis, hypercoagulability, endothelial injury

Clinical features

  • Unilateral limb swelling, pain, warmth, tenderness along vein

Investigations

  • Wells DVT score
  • D-dimer if low-probability (Wells ≤1)
  • Compression USS (proximal DVT)

Management

  • Anticoagulation: DOAC (apixaban/rivaroxaban)
  • 3 months if provoked; extended if unprovoked/cancer
  • Compression stockings for symptom relief
  • Catheter-directed thrombolysis if iliofemoral + limb-threatening (<14 d)

Complications

  • PE
  • Post-thrombotic syndrome (30%)
  • Phlegmasia cerulea dolens

Prevention

  • VTE prophylaxis: LMWH/mechanical in high-risk hospitalised patients

Related in WardRound

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