From the Guidelines
Deep Vein Thrombosis (DVT) commonly presents with unilateral leg swelling, pain, tenderness, warmth, and redness in the affected limb, with the most common symptoms being extremity edema, pain, and erythema, observed in 80%, 75%, and 26% of patients with DVT, respectively 1. The clinical signs of DVT can be subtle and may not always be present, making diagnosis challenging. According to the most recent study 1, the classic signs of DVT include:
- Unilateral leg swelling
- Pain or tenderness in the affected limb
- Warmth or redness of the skin
- Heaviness or cramping in the leg
- Visible surface veins due to collateral circulation It's essential to note that up to 50% of DVTs are asymptomatic and discovered incidentally 1. The diagnosis of DVT should be tempered by an increased level of clinical suspicion, especially in patients with cancer or other high-risk factors 1. The clinical diagnosis of DVT can be aided by the use of clinical risk-stratification scores, such as the Wells score, in combination with blood evaluation for plasma D-dimer 1. However, the reliability of diagnosis solely on the clinical prediction score and D-dimer testing is limited due to the highly variable nature of DVT presentation and numerous potential pathologic mimics for DVT 1. Imaging studies, such as venous ultrasound, are frequently required to definitively exclude DVT and properly document the extent of venous thrombosis 1. The preferred imaging method for the initial diagnosis of DVT is venous ultrasound, which has been shown to detect asymptomatic DVT of the lower extremities in 34% of patients who are nonambulatory with advanced cancer 1.
From the Research
Clinical Signs of Deep Vein Thrombosis (DVT)
The clinical signs of DVT can vary, but common symptoms and signs include:
- Pain in the affected limb 2
- Swelling of the affected limb 2, 3
- Erythema (redness) in the affected limb 2
- Dilated veins in the affected limb 2
- Skin discoloration 4
- Cosmetic appearance changes 4
- Activity tolerance changes 4
- Emotional distress 4
- Leg-related sleep problems 4
Location and Frequency of DVT
DVT can occur in either the upper or lower extremities, but it is more common in the lower extremities 5. The site of DVT is more common in left extremities and proximal veins 3.
Risk Factors for DVT
Risk factors for DVT include:
Diagnosis and Management of DVT
Diagnosis of DVT requires a multifaceted approach that includes clinical assessment, evaluation of pre-test probability, and objective diagnostic testing 2. Management of DVT typically involves anticoagulation to control symptoms, prevent progression, and reduce the risk of post-thrombotic syndrome and pulmonary embolism 2, 6.