Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • calf swelling
  • localised pain along deep venous system

Other diagnostic factors

  • asymmetric oedema
  • collateral superficial veins
  • swelling of the entire leg
  • phlegmasia cerulea dolens

Risk factors

  • medical hospitalisation within the past 2 months
  • major surgery within 3 months
  • active cancer
  • lower-extremity trauma
  • increasing age
  • pregnancy
  • obesity
  • factor V Leiden
  • prothrombin gene mutation G20210A
  • protein C or S deficiency
  • antithrombin deficiency
  • antiphospholipid antibody syndrome
  • medical comorbidity
  • recent long-distance air travel
  • use of specific drugs
  • family hx

Diagnostic investigations

1st investigations to order

  • Wells' clinical probability tool
  • quantitative D-dimer level
  • venous duplex ultrasound (DUS)
  • INR and activated partial thromboplastin time (aPTT)
  • urea and creatinine
  • LFTs
  • FBC
Full details

Investigations to consider

  • Doppler venous flow testing
  • CT abdomen and pelvis with contrast
  • thrombophilia screen
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Co-Director

Jefferson Vascular Center

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

GM has received grant or research support from BMS, J&J, Sanofi-Aventis, Portola, and Janssen; he has served as a Scientific Consultant for BMS, J&J, and Sanofi-Aventis.

Assistant Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

TG declares that he has no competing interests.

Assistant Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

LE declares that he has no competing interests.

Assistant Professor of Medicine and Surgery

Section of Vascular Medicine, Department of Surgery

Sidney Kimmel Medical College at Thomas Jefferson University

Thomas Jefferson University Hospitals

Philadelphia

PA

Disclosures

GO declares that he has no competing interests.

Dr Geno Merli, Dr Taki Galanis, Dr Luis Eraso, and Dr Geoffrey Ouma would like to gratefully acknowledge Dr Richard White and Dr Windsor Ting, the previous contributors to this monograph. RW declares participation in numerous multicentered clinical trials sponsored by companies: Agenix, Boehringer-Ingleheim, Amgen, Bayer, Bristol-Meyer-Squibb, Novartis, Hemosense. WT declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Medicine

Co-Director, Thrombosis Clinic

Intermountain Medical Center

Murray

UT

Disclosures

SMS is co-investigator on an active trial of warfarin pharmacogenetics sponsored by Iverson Genetics, and on an active trial of the effect of active physician alerting for VTE prevention, sponsored by TWINE LLC. He has previous research contracts for trials of apixaban and rivaroxaban, and research subcontracts from the National Institute of Health (warfarin pharmacogenetics) and Canadian Institute of Health Research (use of D-dimer testing for anticoagulation cessation). SMS was a panelist on the 9th Antithrombotic guidelines panel (Diagnosis of DVT chapter) of the ACCP, and he is currently a panelist on the 10th edition (Therapy of VTE chapter).

Professor of Thrombosis & Haemostasis

King's College

Consultant

Departments of Haematology, Pathology & Rheumatology

Lead in Blood Sciences

Guy's & St Thomas' NHS Foundation Trust

London

UK

Disclosures

BH declares that she has no competing interests.

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