Deep Vein Thrombosis
DPT 732
SPRING 2009
S. SCHERER
Objectives
 Discuss etiology of DVT
 Identify signs & symptoms of DVT
 Discuss diagnostic criteria for DVT
 Identify ambulation criteria for patients with acute
DVT
What is a DVT?
 Blood clot in a deep vein
 Occurs due to:
 Decreased blood flow rate
 Damage to vessel wall
 Hypercoagulability
Complications of DVT
 Pulmonary Embolus
 Signs/symptoms
 Shortness of breath
 Rapid pulse
 Sweating
 Sharp chest pain
Diagnostic Criteria for DVT
 Active Cancer
 Recent immobilization
 Recently bedridden > 3 days or major surgery within
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


4 weeks
Localized tenderness
Entire leg swelling
Calf swelling > 3 cm
Pitting edema
Wells, et al 1997
Application of Clinical Decision Rule
Moderate
probability
Score of 1-2
Low Pretest
Probability
Score of 0 or less
Ddimer
negative
High Probability
Score of 3 or
more
Ultrasound
Ultrasound
positive
negative
positive
positive
Ultrasound
NO
DVT
negative
NO
DVT
positive
DVT
DVT
DVT
Case Study
 41 y.o. female had ACL reconstruction 7 days ago
 No post operative anticoagulation therapy
 Past 2 days sitting in chair or in bed
 Past 2 days had discomfort in calf and swelling (4 cm
greater than other leg)
 No history of DVT
 Score of 1


1 point bedrest, 1 point calf swelling, 1 point tenderness
- 2 points for alternate diagnosis (post-op swelling)
Treatment of DVT
 Low molecular Weight Heparin or warfarin
 Elastic compression stockings
 Pneumatic compression devices
When can the Patient Ambulate?
 Start therapeutic doses of anticoagulation
 walk as soon and as much as possible with good
compression therapy
 Leads to better outcomes



decreased pain
decreased swelling
decreased occurrence/severity of postthrombotic syndrome
(Partsch, 2001).
Other questions
 Early ambulation does not increase the incidence of
PE in patients with DVT
 Bed rest does not decrease incidence of PE
 Bed rest increases size of DVT
How much walking?
 RCT of 45 patients treated with dalteparin, 200 IU/kg





per body weight
Group 1- rigid bandages 50 mmHg pressure
Group 2 thigh high compression stockings (35 mmHg)
Group 3 no compression
Walked between 600-12,000 meters/day
After 9 days



Leg swelling and pain decreased in compression groups (p < .01)
QOL improved in compression groups
No increased incidence of PE
Conclusion
 Early ambulation is not associated with an increased
risk for pulmonary embolism in anticoagulated
patients with acute deep vein thromboses.



Ensure patients are anticoagulated
Apply compression
Encourage walking after 8 hours anticoagulation
 References
 Partsch, 2000, 2001