Deep venous thrombosis is a blood clot in a deep vein, usually in the leg, triggered by slow flow, vessel injury or a tendency to clot. Most stable patients can be diagnosed and treated at home with oral anticoagulants, as long as they have no signs of pulmonary embolism and a low bleeding risk.
Key symptoms
- Swelling of one leg
- Calf or thigh pain or tenderness
- Warmth and redness of the leg
- Recent surgery, travel, bed rest, cancer or estrogen use
What you find on exam
- Calf circumference more than 3 cm larger than the other side
- Pitting edema and tenderness along the deep veins
- Dilated surface veins
- Heart rate, breathing rate and oxygen saturation to look for pulmonary embolism
Tests
- Wells score to set the pretest probability
- D-dimer when probability is low; a normal result rules out DVT
- Compression ultrasound when probability is high or D-dimer is positive
- Blood count, kidney and liver function, clotting tests before treatment
Treatment basics
- Direct oral anticoagulant such as apixaban or rivaroxaban, started right away
- At least 3 months of treatment; longer if unprovoked or the risk persists
- Teach bleeding signs and the importance of taking every dose
- Walk as tolerated; compression stockings for symptoms
- Admit if severe symptoms, high bleeding risk or pulmonary embolism
Red flags
- Sudden breathlessness, chest pain or coughing blood
- Massive swelling with a blue or white leg
- Bleeding while on anticoagulants
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.