Deep Vein Thrombosis

Authors: James Simon Dunn, Jason M Kendall / Editor: Gavin Lloyd / Reviewer: Sarah Hickin-Yacoub, Peter Kilgour, Mehdi Teeli / Codes: / Published: 22/02/2024

This session will deal with the assessment and management of possible deep vein thrombosis (DVT) in the emergency department (ED).

After completing this session you will be able to:

  • Describe the pathophysiology of Deep Vein Thrombosis (DVT)
  • Risk stratify patients presenting with possible DVT
  • Plan an appropriate investigative strategy to rule in or out DVT
  • Start treatment for patients with proven DVT

References

  1. Scarvelis D, Wells PS. Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006 Oct 24;175(9):1087-92.
  2. Encyclopaedia Britannica. Rudolf Virchow. [Accessed Feb 2024].
  3. Jones S. SimpliRed and diagnosis of deep venous thrombosis. BestBets.org. 2003.
  4. National Institute for Health and Clinical Excellence (NICE). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NG 158, 2020. Updated: 2 August 2023.
  5. Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003 Sep 25;349(13):1227-35.
  6. Wells PS, Owen C, et al. Does this patient have deep vein thrombosis? JAMA. 2006 Jan 11;295(2):199-207.
  7. Schutgens RE, Ackermark P, Haas FJ, et al. Combination of a normal D-dimer concentration and a non-high pretest clinical probability score is a safe strategy to exclude deep venous thrombosis. Circulation. 2003 Feb 4;107(4):593-7.
  8. Gardiner C, Pennaneac’h C, et al. An evaluation of rapid D-dimer assays for the exclusion of deep vein thrombosis. Br J Haematol. 2005 Mar;128(6):842-8.
  9. Goodacre S, Sampson F, et al. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging. 2005 Oct 3;5:6.
  10. Bller HR, Davidson BL, Decousus H, Gallus A, et al. Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med. 2004 Jun 1;140(11):867-73.
  11. Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database of Systematic Reviews 2021, Issue 1. Art. No.: CD002783.
  12. Greenfield LJ, Proctor MC. Twenty-year clinical experience with the Greenfield filter. Cardiovasc Surg. 1995 Apr;3(2):199-205.
  13. Othieno R, Okpo E, Forster R. Home versus inpatient treatment for deep vein thrombosis. Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD003076..
  14. National Institute for Health and Clinical Excellence (NICE). Venous thromboembolism: diagnosis and anticoagulation treatment. 2023.

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