basic understanding about DVT

5. Javed Iqbal
FCPS, FRCS
Professor Of Surgery
Quaid-e-Azam Medical
College, Bahawalpur

6. Deep vein thrombosis

7. It is a serious disease
 Sudden death
 Long term morbidity
• Chronic venous insufficiency
• Ulceration

8. Its incidence is
underestimated
10% of all hospitalized deaths
are due to DVT/PE

9. Virchow’s triad
 Change in vessel wall
• Injury
• Inflammation
 Stagnation
• Hospitalized patients
 Increased coagubility
• Surgery
• Malignancy
• Thrombophilia

10. Thrombophillia
 Anti-thrombin III deficiency
 Protein C and S deficiency
 Anti-phospholipid antibodies
 Dysfibrogenaemia

11. Predisposing factors/situations
 Old age
 prolonged surgical procedures
 Procedures on Hip and pelvis
 Spleenectomy
 Gyaenacological procedures
 Stroke / and other neurological
ailments

12.  Myocardial Infarction / CCF
 Oral contraceptives / steroids
 Obesity
 Varicose veins
 Pregnancy
 malignancy

13. Air Travel
 Immobility
 Hypoxia
 Decreased cabin pressure
10 % of all passengers
of long flights

14. E-thrombosis

15. What to do?

16. Don’t let it happen
Prophylaxis

17. Every unit must have its
own DVT prophylaxis policy
According to local
circumstances

18. The most important point is
to keep in mind that DVT
does exist

19. The standard guideline is to
define and identify the risk
groups

20. Low Risk
 Young patients with minor ailment
having no risk factor and undergoing
a procedure of less than an hour

21. Moderate risk
 Patient over 40 with debilitating
illness
 Patient above 40 undergoing major
surgical procedure
 But there is no risk factor

22. High Risk
 Patient over 40
 Serious medical illness
 Major surgery
 Additional risk factor

23. Principals of Prevention

24. 1
Minimizing the
correctable risk factors

25. 2
Mechanical measures

26.  Graduated compression dressing
(TEDS)
 Sequential pneumatic compression
 Early ambulation

28. 3
Pharmacological
intervention

29.  Low dose (sub-cut) heparin : 5000
units bid
 Low molecular weight heparin

30. All moderate and high risk
patients must have some
DVT prophylaxis

31. If DVT does occur!

32. Symptoms/signs/labs
 Leg pain
 Swelling
 Redness
 Fever
 Increased TLC

33. D-Dimer

34. Doppler studies

35. 55% of DVT is in pelvic
veins

36. Treatment
 Anticoagulation: Hepranization
 Elevation of limb
 Monitering

37. Pulmonary embolism

38. Massive embolism
Massive embolism

39. Medium vessel
embolism

40. Small vessel embolism

41.  Dyspnoea
 Cough
 Haemoptysis
 Hypoxia
 Acute right shift on ECG
 X-ray chest

42. Management
 Hepranization
 Standard resuscitation
 Antibiotics
 Long term anticoagulation

43. Thank you