Dvt

Javed IqbalJaved IqbalFCPS, FRCSFCPS, FRCS

Professor Of SurgeryProfessor Of Surgery

Quaid-e-Azam Medical Quaid-e-Azam Medical College, BahawalpurCollege, Bahawalpur

Deep vein thrombosisDeep vein thrombosis

It is a serious diseaseIt is a serious disease

Sudden deathSudden death Long term morbidityLong term morbidity

• Chronic venous insufficiency Chronic venous insufficiency • UlcerationUlceration

Its incidence is Its incidence is underestimatedunderestimated

10% of all hospitalized deaths 10% of all hospitalized deaths are due to DVT/PEare due to DVT/PE

Virchow’s triadVirchow’s triad

Change in vessel wallChange in vessel wall• InjuryInjury• InflammationInflammation

StagnationStagnation• Hospitalized patientsHospitalized patients

Increased coagubilityIncreased coagubility• SurgerySurgery• MalignancyMalignancy• ThrombophiliaThrombophilia

ThrombophilliaThrombophillia

Anti-thrombin III deficiencyAnti-thrombin III deficiency Protein C and S deficiencyProtein C and S deficiency Anti-phospholipid antibodiesAnti-phospholipid antibodies DysfibrogenaemiaDysfibrogenaemia

Predisposing factors/situationsPredisposing factors/situations

Old ageOld age prolonged surgical proceduresprolonged surgical procedures Procedures on Hip and pelvisProcedures on Hip and pelvis SpleenectomySpleenectomy Gyaenacological proceduresGyaenacological procedures Stroke / and other neurological Stroke / and other neurological

ailmentsailments

Myocardial Infarction / CCFMyocardial Infarction / CCF Oral contraceptives / steroidsOral contraceptives / steroids ObesityObesity Varicose veinsVaricose veins PregnancyPregnancy malignancymalignancy

Air TravelAir Travel

ImmobilityImmobility HypoxiaHypoxia Decreased cabin pressureDecreased cabin pressure

10 % of all passengers of long flights

E-thrombosisE-thrombosis

What to do?What to do?

Don’t let it happenDon’t let it happen

ProphylaxisProphylaxis

Every unit must have its Every unit must have its own DVT prophylaxis policyown DVT prophylaxis policy

According to local According to local circumstancescircumstances

The most important point is The most important point is to keep in mind that DVT to keep in mind that DVT

does existdoes exist

The standard guideline is to The standard guideline is to define and identify the risk define and identify the risk

groups groups

Low RiskLow Risk

Young patients with minor ailment Young patients with minor ailment having no risk factor and undergoing having no risk factor and undergoing a procedure of less than an houra procedure of less than an hour

Moderate riskModerate risk

Patient over 40 with debilitating Patient over 40 with debilitating illness illness

Patient above 40 undergoing major Patient above 40 undergoing major surgical proceduresurgical procedure

But there is no risk factorBut there is no risk factor

High RiskHigh Risk

Patient over 40Patient over 40 Serious medical illnessSerious medical illness Major surgeryMajor surgery Additional risk factorAdditional risk factor

Principals of PreventionPrincipals of Prevention

Minimizing the Minimizing the correctable risk factorscorrectable risk factors

1

Mechanical measuresMechanical measures

2

Graduated compression dressing Graduated compression dressing (TEDS)(TEDS)

Sequential pneumatic compressionSequential pneumatic compression Early ambulation Early ambulation

Pharmacological Pharmacological interventionintervention

3

Low dose (sub-cut) heparin : 5000 Low dose (sub-cut) heparin : 5000 units bidunits bid

Low molecular weight heparinLow molecular weight heparin

All moderate and high risk All moderate and high risk patients must have some patients must have some

DVT prophylaxisDVT prophylaxis

If DVT does occur!If DVT does occur!

Symptoms/signs/labsSymptoms/signs/labs

Leg painLeg pain SwellingSwelling RednessRedness FeverFever Increased TLCIncreased TLC

D-DimerD-Dimer

Doppler studiesDoppler studies

55% of DVT is in pelvic 55% of DVT is in pelvic veinsveins

TreatmentTreatment

Anticoagulation: HepranizationAnticoagulation: Hepranization Elevation of limbElevation of limb MoniteringMonitering

Pulmonary embolismPulmonary embolism

Massive embolismMassive embolism

Massive embolismMassive embolism

Medium vessel Medium vessel embolismembolism

Small vessel embolismSmall vessel embolism

DyspnoeaDyspnoea CoughCough HaemoptysisHaemoptysis HypoxiaHypoxia Acute right shift on ECGAcute right shift on ECG X-ray chestX-ray chest

ManagementManagement

HepranizationHepranization Standard resuscitationStandard resuscitation AntibioticsAntibiotics

Long term anticoagulationLong term anticoagulation

Thank you