Clinical Overview Template ( Deep Vein Thrombosis )

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CLINICAL OVERVIEW TEMPLATE (Deep Vein Thrombosis)

TERMINOLOGY
CLINICAL CLARIFICATION o Deep vein thrombosis is a type of venous thromboembolism that usually occurs in the legs. 1 o DVT is associated with an increased risk for pulmonary embolism when above the knee (popliteal vein and above) 1 o Often presents with unilateral leg swelling, redness, or pain in the calf or thigh 2 o Generally, 10% to 20% of patients investigated have deep vein thrombosis2 CLASSIFICATION 4 o Lower extremity 3
• Above the knee
• Below the knee o Upper extremity
• Less common than lower extremity
 Most related to thoracic outlet syndrome 4
• Secondary causes 4
 Genetic, such as hypercoagulable state
 Acquired, associated with central lines, venous
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ncy, birth control pills Age
• Risk of deep vein thrombosis increases with age >60 Sex
• NA Genetics
• Family history of venous thromboembolism Ethnicity/race
• 2.5 to 4 fold lower risk in Hispanics and Asian-Pacific islanders compared to white and African American patients 5 Other risk factors/associations
• History of deep vein thrombosis
• Obesity
• Presence of cancer
• Surgery
• Orthopedic surgery
• Post partum or current use of estrogens
• Airplane flights >8 hours
• Smoking DIAGNOSTIC PROCEDURES Primary diagnostic tools
 Diagnostic algorithm 2, 1
 Clinical findings alone poor predictors of deep vein thrombosis; necessary to determine clinical pretest probability 4 o Can determine pretest probability with Wells Prediction Rule 6, 1 o If low probability, perform D-dimer testing
• D-dimer negative, no further work-up
• D-dimer positive, obtain venous ultrasound
• Ultrasound normal, no further testing
• Ultrasound abnormal, treat o If high probability of DVT, perform venous ultrasound
• Ultrasound abnormal, treat for deep vein thrombosis
• Ultrasound normal, perform D-dimer testing
• D-dimer negative, no further workup
• D-dimer positive, repeat ultrasound in 7 days, or perform venography 2, 4

 Wells Prediction Rule 1,2,6
• Uses signs, symptoms, and risk factors to categorize patients as low, medium, or high risk for deep vein thrombosis 2,1
• Individual factors not as useful as when combined in Wells criteria 7 o Assigned +1 point each:
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