DVT/PE

Question 1

Diagnosis of DVT

Answer 1

Well's Criteria: (all +1)
Active cancer (w/in 6 mo)
Bedridden recently >3 days OR major surgery (w/in 4 wks)
Calf swelling >3cm compared to other leg
Collateral superficial veins present
Entire leg swollen
Localized TTP along deep venous system
Pitting edema (UL)
Paralysis, paresis, recent immobilization
Hx of DVT

Alternative Dx more likely (-2)

0 = unlikely DVT
1-2 = moderate risk of DVT (d-dimer & US)
3+ = DVT likely (still do d-dimer & US)

Question 2

Lab and Imaging for DVT

Answer 2

D-Dimer

Doppler US of affected extremity

Question 3

Complications of DVT

Answer 3

Pulmonary embolism (PE)
Post-thrombotic syndrome (vein/valve damage)
Renal vein thrombosis
MI
Ischemic stroke

Question 4

Tx of DVT

Answer 4

Warfarin (target INR btwn 2-3) w/Fish oil and/or Nattokinase (CHECK DOSAGE FOR ALL)

Pressure hose stockings, leg elevation, gentle/graduated exercises

No heavy lifting

Goals: resolution of d-dimer, fibrinogen level btwn 250-300, bleeding times 8-12 minutes, circumference of leg resolved, improvement on vascular US in 3-6 months