Approach to the diagnosis and therapy of lower extremity deep vein thrombosis
- Kenneth A Bauer, MD
Kenneth A Bauer, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
- Jess Mandel, MD
Jess Mandel, MD
- Section Editor — Pulmonary Vascular Disease
- Professor of Medicine
- University of California, San Diego
Deep vein thrombosis (DVT) and acute pulmonary embolism (PE) are two manifestations of the same disorder, venous thromboembolism (VTE). DVT of the lower extremity is subdivided into two categories:
●Distal (calf) vein thrombosis, in which thrombi remain confined to the deep calf veins
●Proximal vein thrombosis, in which thrombosis involves the popliteal, femoral, or iliac veins
Proximal vein thrombosis is of greater importance clinically, since it is more commonly associated with the development of pulmonary emboli. (See "Overview of the treatment of lower extremity deep vein thrombosis (DVT)", section on 'Introduction'.)
There are a number of questions that arise when a patient is suspected of having deep vein thrombosis (DVT) of the lower extremity. These include:
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- INITIAL APPROACH
- - Family history
- - Special clinical settings
- Physical examination
- - Phlegmasia cerulea dolens
- Screening for malignancy
- Laboratory testing
- DIFFERENTIAL DIAGNOSIS
- Superficial thrombophlebitis
- Venous valvular insufficiency
- Popliteal (Baker's) cyst
- Internal derangement of the knee
- Drug-induced edema
- Calf muscle pull or tear
- DIAGNOSIS OF DVT
- Pretest probability
- - Wells score
- SCREENING FOR A HYPERCOAGULABLE STATE
- Inherited and acquired hypercoagulable states
- Whom to test
- Value of screening
- Screening test interference
- TREATMENT OF DVT
- Initial therapy
- Duration of treatment
- General medical management
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Suspecting the diagnosis
- - Pretest probability
- Confirming the diagnosis
- Screening for hypercoagulable conditions
- Treatment duration