From the Guidelines
Deep Vein Thrombosis (DVT) typically presents with local pain or tenderness, edema, and swelling of the lower extremity, but approximately one-third of patients are asymptomatic.
Clinical Presentations
- Local pain or tenderness
- Edema and swelling of the lower extremity
- However, symptoms are often not apparent until there is involvement above the knee 1
Diagnosis
- Clinical risk-stratification scores, such as the Wells score, can be used in combination with a blood evaluation for plasma D-dimer to diagnose DVT 1
- Imaging, such as lower extremity ultrasound, is frequently required to definitively exclude DVT and properly document the extent of venous thrombosis 1
Important Considerations
- DVT can be limited to the infrapopliteal calf veins (below-the-knee or distal DVT) or extend proximally above the knee (above-the-knee or proximal DVT) 1
- Proximal DVT is strongly associated with an increased risk for pulmonary embolism, while distal DVT rarely results in pulmonary embolism 1
- The treatment of choice for DVT is anticoagulation to reduce the risk of DVT extension, recurrent DVT, pulmonary embolism, and post-thrombotic syndrome 1
From the Research
Clinical Presentations of Deep Vein Thrombosis (DVT)
The clinical presentations of DVT can vary, but common symptoms include:
- Unilateral painful swelling in the limb 2
- Leg pain (62%) and leg swelling (87%) 3
- Whole limb enlargement, one-sided calf enlargement, and dilatation of superficial veins 4
- The clinical presentation can also vary depending on the anatomic distribution of the DVT, with the most frequently thrombosed segments being popliteal, posterior tibial, and profunda femoris veins 5
Risk Factors for DVT
Risk factors for DVT include:
- Immobilization 4, 2, 3
- Presence of cancer 4, 2, 3
- Confinement to bed 4
- Previous major surgery 4, 2, 3
- Prior VTE 4, 2, 3
- Smoking history (44%) 3
- Recent surgery (15%) 3
- Malignancy (11%) 3
- History of immobility (10%) 3
- Past history of DVT (15%) 3
Diagnostic Considerations
Diagnostic prediction rules, such as the Wells pre-test probability score for DVT or PE, can be useful in assessing pre-test probability and guiding diagnostic algorithms 4. The clinical presentation and risk factors can be used to determine the pre-test probability for VTE, which is an important concept for the diagnosis of DVT and PE 4.