Summary
Definition
History and exam
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
Investigations to consider
- Doppler venous flow testing
- CT abdomen and pelvis with contrast
- thrombophilia screen
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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