Lancaster Physician Summer 2021 - 24

L A N CA S TERMED I CALSO C IET Y. O R G
Healthy Communities
guidelines for prophylaxis can be reviewed
in CHEST Guideline for Antithrombotic
Therapy in VTE.
DEEP VEIN
THROMBOSIS
IS OFTEN
PREVENTABLE.
Proper treatment of deep vein thrombosis
is also critical. Anticoagulation, the mainstay
of therapy, can be accomplished with
heparin and warfarin, or the use of newer
direct thrombin inhibitors such as Eliquis® or
Xarelto®. The extent and location of the DVT
are important in determining the length of
treatment as are the associated risk factors,
such as malignancy or hypercoagulable state.
It is also vital to realize that thrombolytic
therapy may be indicated in the case of
extensive lower extremity deep vein thrombosis
and should be strongly considered in
acute iliofemoral deep vein thrombosis,
which involves the iliac veins and common
femoral veins. Thrombolytic therapy can
prevent postthrombotic syndrome.
Deep vein thrombosis is often preventable.
It is important to have a clinical suspicion
for DVT and to follow the proper diagnostic
and treatment protocols to prevent the major
complications from deep vein thrombosis.
Today the gold standard is venous duplex
imaging. If this study is positive, DVT treatment
should be started. If the ultrasound is
negative, clinical stratification is necessary. In
patients with low probability of DVT and a
negative duplex scan, no further studies are
necessary. If clinical suspicion is moderate,
then repeat duplex imaging should be performed
in three to five days, or a D-dimer
blood test should be performed. A positive
D-dimer blood test should be followed up
with ascending venography (an invasive
imaging study) or a magnetic resonance
venogram (MRV). High-risk patients with a
negative duplex ultrasound should undergo
MRV or phlebography.
Deep vein thrombosis is a serious medical
condition with some very devastating
potential complications. Prevention is the
best treatment and early diagnosis is important
for avoiding serious issues. Appropriate
LANCASTER 24 PHYSICIAN

Lancaster Physician Summer 2021

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