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Deep vein thrombosis

Última revisión: 23 Sep 2025
Última actualización: 16 Apr 2025

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

  • calf swelling
  • localized pain along deep venous system
Todos los datos

其他诊断因素

  • asymmetric edema
  • prominent superficial veins
  • swelling of the entire leg
  • phlegmasia cerulea dolens
完整详情

危险因素

  • 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
完整详情

诊断性检查

首要检查

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

需考虑的检查

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

治疗流程

初步治疗

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

急症处理

treatment-phase therapy

持续性治疗

extended-phase therapy: provoked DVT

extended-phase therapy: unprovoked DVT

extended-phase therapy: pregnant

extended-phase therapy: cancer-associated

extended-phase therapy: recurrent VTE

撰稿人

作者

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

利益声明

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

利益声明

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

Declarações

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

Agradecimentos

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.

Declarações

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.

Revisores

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

Declarações

BH declares that she has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021 Dec;160(6):e545-608.Texto completo  Resumo

Mazzolai L, Ageno W, Alatri A, et al. Second consensus document on diagnosis and management of acute deep vein thrombosis: updated document elaborated by the ESC Working Group on aorta and peripheral vascular diseases and the ESC Working Group on pulmonary circulation and right ventricular function. Eur J Prev Cardiol. 2022 May 27;29(8):1248-63.Texto completo  Resumo

Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 suppl):e195S-226S.Texto completo  Resumo

Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: compendium and review of CHEST guidelines 2012-2021. Chest. 2024 Aug;166(2):388-404.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Deep vein thrombosis images
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    • Calf muscle tear/Achilles tendon tear
    • Calf muscle hematoma
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  • Diretrizes

    • NCCN clinical practice guidelines in oncology: cancer-associated venous thromboembolic disease
    • ACR-AIUM-SPR-SRU practice parameter for the performance of peripheral venous ultrasound examination
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  • Folhetos informativos para os pacientes

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    DVT and long-distance travel

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  • Calculadoras

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

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