Deep vein thrombosis

Last reviewed: 29 Oct 2022
Last updated: 01 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • calf swelling
  • localized pain along deep venous system
More key diagnostic factors

Other diagnostic factors

  • asymmetric edema
  • prominent superficial veins
  • swelling of the entire leg
  • phlegmasia cerulea dolens
Other diagnostic factors

Risk factors

  • 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
  • paralysis of the lower extremities
  • 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-distance air travel
  • family history
  • central venous catheterization
More risk factors

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)
  • BUN and creatinine
  • LFTs
  • CBC
More 1st investigations to order

Investigations to consider

  • Doppler venous flow testing
  • CT abdomen and pelvis with contrast
  • thrombophilia screen
More investigations to consider

Treatment algorithm

INITIAL

initiation-phase therapy: no active bleeding

initiation-phase therapy: active bleeding

ACUTE

treatment-phase therapy

ONGOING

extended-phase therapy (3 months’ anticoagulation therapy completed): not postpartum, no recurrence

extended-phase therapy: postpartum (planning to breastfeed)

extended-phase therapy: postpartum (not planning to breastfeed)

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 serves as co-chair of the American College of Chest Physicians guideline on the treatment of venous thrombotic disease. He is the author of several references cited in this topic.

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 guideline on the treatment of venous thrombotic disease. He is the author of several references cited in this topic.

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 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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  • Calculators

    Modified Wells score for deep vein thrombosis (DVT)

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