DVT

Definition

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Deep vein thrombosis (DVT) is the term used to describe the formation of a thrombus (blood clot) in a deep vein, which partially or completely obstructs blood flow.

The thrombus can dislodge and travel in the blood, especially to the pulmonary arteries. This is known as a pulmonary embolism (PE). For more information, see the CKS topic on Pulmonary embolism.

Thrombosis usually affects the deep veins of the legs or pelvis,
but may affect other sites such as the upper limbs and the intracranial and splanchnic veins [

Suspect DVT

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Pain and swelling in one leg, although both legs may be affected.

Tenderness, changes to skin colour and temperature, and vein distension.

Carry out a physical examination and review the person's general medical history
to exclude an alternative cause for the symptoms and signs.

Use the two-level DVT Wells score to assess the likelihood
of DVT and inform further management.

Risk factors

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Previous venous thromboembolism.

Cancer (known or undiagnosed).

Age over 60 years.

Being overweight or obese.

Male sex.

Heart failure.

Severe infection.

Acquired or familial thrombophilia.

Chronic low-grade injury to the vascular wall, hypoxia from venous stasis, or chemotherapy).

Varicose veins [Muller-Buhl et al, 2012].

Smoking

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Immobility (for example following a stroke, operation, plaster cast, hospitalization, or during long-distance travel).

Significant trauma or direct trauma to a vein.

Hormone treatment (for example oestrogen-containing contraception or hormone replacement therapy).

Pregnancy and the postpartum period.

Dehydration

Management

Use WELLS score to assess risk- if score above 2 then DVT
likely.

Ensure that people with unprovoked DVT are investigated for the possibility of an undiagnosed cancer if they are not already known to have cancer

Referral for same day assessment - scan & bloods

Ensure that people with unprovoked DVT have been offered thrombophilia testing, as appropriate

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Ensure adequate monitoring of anticoagulation therapy

Specialists will make clinical decisions such as the choice of
anticoagulant and the duration of treatment.

Treatment is usually continued for at least 3 months,
but duration may be longer depending on whether the DVT was unprovoked