Last reviewed: December 2018
Last updated: November  2018

Summary

Definition

History and exam

Key diagnostic factors

  • calf swelling
  • localized pain along deep venous system

Other diagnostic factors

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

Risk factors

  • medical hospitalization 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

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
Full details

Investigations to consider

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

Treatment algorithm

Contributors

Authors VIEW ALL

Director

Thrombosis Clinic

Intermountain Medical Center

Murray

Professor of Medicine

University of Utah

Salt Lake City

UT

Disclosures

SMS is an investigator for two investigator-initiated clinical trials for which his institution receives funds from Bristol-Myers Squibb to enrol patients.

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 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 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 VIEW ALL

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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