Deep vein thrombosis

Last reviewed: 24 Apr 2022
Last updated: 10 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • calf swelling
  • localised pain along deep venous system
  • presence of risk factors
  • positive Wells score
  • redness and warmth
  • coolness
Full details

Other diagnostic factors

  • asymmetric oedema
  • prominent superficial veins
  • swelling of the entire leg
  • cyanosis
Full details

Risk factors

  • recently bedridden for 3 days or more
  • major surgery within the preceding 12 weeks
  • medical hospitalisation within the preceding 2 months
  • active cancer
  • previous venous thromboembolic event
  • recent trauma or fracture
  • increasing age
  • pregnancy and the postnatal period
  • paralysis, paresis, or recent plaster immobilisation of the lower extremities
  • factor V Leiden
  • prothrombin gene G20210A mutation
  • protein C or protein S deficiency
  • antithrombin deficiency
  • antiphospholipid antibody syndrome
  • medical comorbidity
  • use of specific drugs
  • obesity
  • cigarette smoking
  • recent long-distance air travel
  • family history
Full details

Diagnostic investigations

1st investigations to order

  • quantitative D-dimer level
  • venous ultrasound
  • full blood count
  • urea and creatinine
  • liver function tests
  • clotting screen
Full details

Investigations to consider

  • CT/MRI venography
  • further investigation for unprovoked DVT
Full details

Treatment algorithm

INITIAL

suspected DVT of the leg

ACUTE

initiation-phase therapy: confirmed proximal DVT of the leg

initiation phase therapy: confirmed distal DVT of the leg

ONGOING

treatment-phase therapy: confirmed DVT of the leg

extended-phase therapy: confirmed DVT of the leg

recurrent venous thromboembolism

Contributors

Expert advisers

Ian Chetter, MBChb, FRCS (eng), MD, FRCS (Gen surg), PGCert Medical Ultrasound, PGDip Clinical Education

Chair of Surgery

University of Hull

Honorary Consultant Vascular Surgeon

Hull University Teaching Hospitals NHS Trust

Hull

UK

Disclosures

IC declares he has no competing interests

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Scott M. Stevens, MD

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Scott C. Woller, MD

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

Professor of Medicine

Department of Medicine

Intermountain Healthcare and University of Utah

Salt Lake City

UT

Gabriel V. Fontaine, PharmD, MBA, BCPS

Clinical Pharmacy Manager

Critical Care and Emergency Medicine

Advanced Clinical Pharmacist

Neuroscience Critical Care

Intermountain Medical Center

Murray

UT

Disclosures: SMS declares that he has no competing interests. SCW serves as co-chair of the American College of Chest Physicians (CHEST) guideline on the treatment of venous thrombotic disease. GVF has received consulting fees and honoraria from Alexion Pharmaceuticals.

Peer reviewers

Lara Roberts, MBBS, MD(Res), MRCP, FRCPath

Consultant Haematologist

King's College Hospital

London

UK

Disclosures

LR declares that she has no competing interests.

Steve Goodacre, MBChB, MRCP, DipIMC, FRCEM, MSc, PhD

Professor of Emergency Medicine

University of Sheffield

Consultant in Emergency Medicine

Sheffield Teaching Hospitals NHS Foundation Trust

Sheffield

UK

Disclosures

SG was Chief Investigator or joint Chief Investigator for the NIHR-funded DiPEP, TiLLI, and VTEAM studies. He has also undertaken consultancy work on behalf of the University of Sheffield for ThinkSono.

Editors

Annabel Sidwell,

Section Editor and Comorbidities Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

  • Deep vein thrombosis images
  • Differentials

    • Cellulitis
    • Calf muscle tear/Achilles' tendon tear
    • Calf muscle haematoma
    More Differentials
  • Guidelines

    • European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis
    • Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
    More Guidelines
  • Calculators

    Modified Wells score for deep vein thrombosis (DVT)

    Pretest Probability of Heparin Induced Thrombocytopenia (4-T's score)

    More Calculators
  • Patient leaflets

    Deep vein thrombosis

    DVT and long-distance travel

    More Patient leaflets
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