Venous Thrombosis (including DVT)

Your Path

  • Venous Thrombosis (including DVT)

Risk Factors

  • Smoking
  • Immobility, w/risk increasing based on duration, e.g. long car ride, plane ride, bed bound
  • Active cancer → in particular mucin secreting adenocarcinomas, NHL, AML, others
  • Meds→ e.g. estrogen
  • Trauma/vascular injury, surgery
  • Chronic intravascular catheters
  • Pregnancy - w/hypercoag state extending ~6w post-partum
  • Chronic inflammatory conditions→ IBD, lupus, Behcet's dz, etc
  • Prior hx DVT or PE
  • Consider biochemical predispositions in particular when unexplained DVT: protein S or C deficiency, Anti-thrombin 3 defic, Prothrombin mutation, factor 5 leiden resistance, anti-phospholipid antibody APL (arterial and venous clots)
  • Acquired predispositions often linked to clots in unusual places: renal vein (nephrotic syndrome); hepatic vein, portal vein, splanchnic veins (Polycythemia Vera, PNH, essential thrombocytosis; protein S, protein C, and antithrombin deficiency; factor V Leiden and prothrombin gene mutations, APL); Arterial and venous unprovoked clots (HIT, ET); hyperhomocystinemia
  • Upper extremity DVT in particular related to cancer and/or central venous catheters
  • Mechanical predispositions that compress veins→ stasis→ clot (portal vein, iliac vein compression w/May-Thurners)
  • Can have contribution from more than one RF

Symptoms

  • Acute swelling of calf/ankle
  • Asymmetric edema
  • Localized discomfort
  • No other explanation for symptoms
  • CP or SOB if also PE

Physical Exam Findings

  • Unilateral edema otherwise unexplained
  • Calf/ankle swelling
  • Sometimes redness
  • Sometimes dilated superficial veins
  • Asymmetric upper extremity swelling for arm DVT
  • Ascites, RUQ pain with hepatic or portal vein thrombosis

Sub-Diseases

Acquired States That Promote Clotting
Mechanical Factors
Thrombophilia (biochemical)

Links