Last reviewed: 25 Sep 2021
Last updated: 22 Apr 2021

Summary

Definition

History and exam

Key diagnostic factors

  • calf swelling
  • localised pain along deep venous system

Other diagnostic factors

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

Risk factors

  • major surgery within the preceding 3 months
  • 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 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
  • central venous catheterisation

Diagnostic investigations

1st investigations to order

  • Wells' score
  • quantitative D-dimer level
  • proximal duplex ultrasound
  • whole-leg ultrasound
  • INR and activated partial thromboplastin time (aPTT)
  • urea and creatinine
  • LFTs
  • FBC

Investigations to consider

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

Treatment algorithm

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 serves as co-chair of the American College of Chest Physicians (CHEST) guideline on the treatment of venous thrombotic disease.

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 Alexion Pharmaceuticals.

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 multicentred 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.

Use of this content is subject to our disclaimer