DVT Treatment Flashcards
What is a DVT
What is a DVT
a blood clot in a deep vei, usually in the lower extremities
Signs and Symptoms of DVT
Signs and Symptoms of DVT
- unilateral leg pain and/or swelling and warmth
- positive humans sign
- elevated D-Dimer
Locations of DVT
Locations of DVT
- Proximal - 70-80% of DVT’s
in deep and superficial femoral veins - Distal DVT
20-30% of DVTs are isolated in veins of the calf, anterior tibial, perineal veins, and posterior tibial veins
LOCATION AFFECTS WHETHER OR NOT WE TREAT A PATIENT
Types of DVT
Types of DVT
- Provoked: caused by a known event such as..
a. long distance travel
b. surgery
c. hospitalization
etc. .. - unprovoked: no identifiable factor causing DVT
Bleed Risk Assessment
categories
Bleed Risk Assessment
Each risk factor gets 1 point if present
- age over 65
- age over 75
- previous bleeding
- cancer
- metastatic cancer
- renal failure
- liver failure
- thrombocytopenia
- previous stroke
- Diabetes
- anemia
- anti platelet therapy
- poor anticoagulant control
- comorbidity and reduced functional capacity
- recent surgery
- frequent falls
- alcohol abuse
- NSAID use
Low risk: 0 factors
Moderate risk: 1 risk factor
Highrisk ; >/=2 risk factors
Treatment choices for pts. with DVT and NO cancer
- DOACS>WARFARIN>LMWH
2. if unprovoked and pt is stopping anticoagulant therapy, suggest aspirin
Length of treatment of DVT
Treatment Length
1B: Patients with proximal DVT or PE: 3 months of anticoagulant therapy
1B-2B: in patients with unprovoked DVT
I. low-moderate bleeding risk, extended anticoagulant therapy (no schedule stop date)
II> high bleeding risk: 3 months of anticoagulant therapy
1B-2B: in pts with DVT of leg or PE and active cancer, we recommend extended anticoagulant therapy (no schedule stop date)
distal DVT treatment
serial imaging for 2 weeks
no need to treat unless sever symptoms or pt is already on an anticoagulant
DVT treatment in pts with cancer
Initial coagulation: LMWH, UFH, fondaparunix or rivaroxaban
Logterm: LMWH, edoxaban, rivaroxaban»> VKA
DOACS greatly increase bleed risk, especially in GI and GU cancers
