Summary
Definition
History and exam
Other diagnostic factors
- asymmetric oedema
- prominent 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
- severe trauma
- increasing age
- pregnancy
- factor V Leiden
- prothrombin gene mutation G20210A
- protein C or S deficiency
- antithrombin deficiency
- antiphospholipid antibody syndrome
- medical comorbidity
- use of specific drugs
- obesity
- recent long-distance air travel
- family history
- smoking
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
Director
Thrombosis Clinic
Intermountain Medical Center
Murray
Professor of Medicine
University of Utah
Salt Lake City
UT
Disclosures
SMS’ institution has received financial support for his conduct of investigator-initiated research from Pfizer/Bristol-Myers Squibb.
Director
Thrombosis Clinic
Intermountain Medical Center
Murray
Professor of Medicine
University of Utah
Salt Lake City
UT
Disclosures
SCW holds two investigator-initiated grants from Bristol-Myers Squibb/Pfizer paid to his employer Intermountain Healthcare for which he receives no compensation. He has been invited to serve as co-chair of the American College of Chest Physicians guideline on antithrombotic therapy for venous thromboembolic disease ('AT11') and serves as an invited panelist for the US Centers for Disease Control and Prevention venous thromboembolism risk assessment model systematic review and guidance panel.
Clinical Coordinator
Critical Care Pharmacy
Advanced Clinical Pharmacist
Neuroscience Critical Care
Intermountain Medical Center
Murray
UT
Disclosures
GVF receives consulting fees and honoraria from Portola Pharmaceuticals for clinical consulting and speaking engagements.
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. 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
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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