Deep Vein Thrombosis Jonathan Fleurat Boston Medical Center Hue, April 2012
Deep Vein Thrombosis
Jonathan FleuratBoston Medical Center
Hue, April 2012
Facts about DVTs
Lower-extremity DVT is the most common site
a prevalence of 1:1000 population
Source of 90% of acute PEs
cause 25,000 deaths per year in the US
Venous AnatomySystem of pumps and valves
RisksMORE COMMON
•Age (>65 years old)
•Immobilization >3 days
•Pregnancy/postpartum
•Major surgery < 4 weeks
•Long plane or car trips >4h
•Cancer
•Previous DVT
•Stroke
•Acute myocardial infarction
•Congestive heart failure
•Sepsis•Intravenous (IV) drug abuse•Oral contraceptives•Estrogens
•LESS COMMON•Nephrotic syndrome•Ulcerative colitis•Multiple trauma•CNS/spinal cord injury•Burns•Lower extremity fractures•Systemic lupus erythematosus (SLE) and the lupus anticoagulant
•Behçet syndrome
•Homocystinuria
•Polycythemia rubra vera
•Thrombocytosis
•Inherited disorders of coagulation/fibrinolysis
•Antithrombin III deficiency
•Protein C deficiency
•Protein S deficiency
•Prothrombin 20210A mutation
•Factor V Leiden
•Dysfibrinogenemias and disorders of plasminogen activation
•I
•Heparin-induced thrombocytopenia (HIT)
PresentationLeg Pain in 50% as chief complaint (Homan’s sign)
Tenderness in 75%
Edema only if complete obstruction
Unilateral or bilateral (higher obstruction- iliacs)
Only 10% on pulmonary embolisms present classically
Ultrousound Technique
Popliteal Compression
Thrombosis of Common Femoral Vein
Hands on Time
Questions???