DVT/PE

Risk Factors

  • Smoking
  • Immobility, w/risk increasing based on degree: 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
  • Biochemical predispositions, consider in particular when unexplained DVT: protein S or C defiicency, Anti-thrombin 3 defic, Prothrombin mutation, factor 5 leiden resistance, anti-phospholipid AB (arterial and venous)
  • Acquired predispositions, often linked to clots in unusual places: nephrotic syndorme (renal vein), p vera (hepatic vein), HIT, ET (arterial and venous), PNH, hyperhomocystinemia
  • Mechanical predispositions that compress veins→ stasis→ clot
  • Can have contribution from more than one RF
  • Upper extremity DVT in particular associated w/central venous catheters and/or cancer

Symptoms

  • Acute
  • Cough
  • SOB
  • Pleuritic cp
  • Hemoptysis

Physical Exam Findings

  • Tachycardia
  • Tachypnea
  • Often clear lungs
  • Less commonly wheezing or findings of effusion
  • Unexplained unilateral leg (or arm if UE DVT) swelling

Links