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Deep vein thrombosis

Last reviewed: 25 Mar 2025
Last updated: 16 Apr 2025

Summary

Definição

History and exam

Key diagnostic factors

  • calf swelling
  • localized pain along deep venous system
Full details

Other diagnostic factors

  • asymmetric edema
  • prominent superficial veins
  • swelling of the entire leg
  • phlegmasia cerulea dolens
Full details

Risk factors

  • recently bed-bound for 3 days or more
  • major surgery within the preceding 3 months
  • medical hospitalization within the preceding 2 months
  • active cancer
  • previous venous thromboembolic event
  • recent trauma or fracture
  • increasing age
  • pregnancy and the postpartum
  • varicose veins
  • paralysis of the lower extremities
  • hereditary thrombophilias
  • factor V Leiden
  • prothrombin gene G20210A mutation
  • protein C or protein S deficiency
  • antithrombin deficiency
  • antiphospholipid syndrome
  • medical comorbidity
  • use of specific drugs
  • obesity
  • cigarette smoking
  • recent long-duration air travel
  • family history of venous thromboembolism
  • central venous catheterization
Full details

Diagnostic tests

1st tests to order

  • Wells score
  • quantitative D-dimer level
  • venous duplex ultrasound (DUS)
  • INR and activated partial thromboplastin time (aPTT)
  • BUN and creatinine
  • LFTs
  • CBC
Full details

Tests to consider

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

Treatment algorithm

INITIAL

suspected or confirmed DVT of the leg with phlegmasia cerulea dolens

suspected or confirmed DVT without phlegmasia cerulea dolens and no contraindications to anticoagulation: initiation-phase therapy

suspected or confirmed DVT without phlegmasia cerulea dolens: contraindications to anticoagulation

ACUTE

treatment-phase therapy

ONGOING

extended-phase therapy: provoked DVT

extended-phase therapy: unprovoked DVT

extended-phase therapy: pregnant

extended-phase therapy: cancer-associated

extended-phase therapy: recurrent VTE

Contributors

Authors

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

Disclosures

SMS declares that he has no competing interests.

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

Disclosures

SCW declares that he is expecting to receive funding of an investigator-initiated grant from Janssen Pharmaceuticals to Intermountain Health with no direct compensation to himself for research in the sum of $500,000 in 2024.

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

GVF has received consulting fees and honoraria from AstraZeneca, Chiesi, and Anticoagulation Forum.

Acknowledgements

Dr Scott M. Stevens, Dr Scott C. Woller, and Dr Gabriel V. Fontaine would like to gratefully acknowledge Dr Geno Merli, Dr Taki Galanis, Dr Luis Eraso, Dr Geoffrey Ouma, Dr Richard White, and Dr Windsor Ting, the previous contributors to this topic.

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. RW declares participation in numerous multicentered clinical trials sponsored by companies: Agenix, Boehringer-Ingleheim, Amgen, Bayer, Bristol-Meyer-Squibb, Novartis, Hemosense. TG, LE, GO, and WT declare that they have no competing interests.

Peer reviewers

Beverly Hunt, FRCP, FRCPath, MD

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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