Deep Venous Thrombosis (DVT) Questions & Answers

Updated: Jun 06, 2019
  • Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Questions & Answers

Overview

What is deep venous thrombosis (DVT)?

What are the symptoms of deep venous thrombosis (DVT)?

Which physical findings suggest deep venous thrombosis (DVT)?

What are the potential complications of deep venous thrombosis (DVT)?

What are the AAFP/ACP recommendations in the workup of deep venous thrombosis (DVT)?

Which lab studies may be useful in the workup of deep venous thrombosis (DVT)?

What are the treatment options for deep venous thrombosis (DVT)?

Which heparin products are used in the treatment of deep venous thrombosis (DVT)?

Which factor Xa inhibitors are used in the treatment of deep venous thrombosis (DVT)?

What are the goals of endovascular therapy for deep venous thrombosis (DVT) and what does treatment include?

What are the AHA recommendations for use of IVC filters in the treatment of deep venous thrombosis (DVT)?

What is venous thromboembolism (VTE)?

What is deep venous thrombosis (DVT) and what is the disease course if left untreated?

Which veins are most commonly involved in deep venous thrombosis (DVT)?

What is the prevalence of deep venous thrombosis (DVT)?

How is venous thrombosis (DVT) diagnosed?

What are the goals of pharmacotherapy for deep venous thrombosis (DVT)?

How likely is postthrombotic syndrome in deep venous thrombosis (DVT)?

What patient education resources are available for deep venous thrombosis (DVT)?

What is the function and anatomy of the peripheral venous system?

What is the anatomy and function of primary collecting veins of the lower extremity?

What is the anatomy and function of collecting veins in the deep venous system?

What is the anatomy and function of paired deep veins in the calf?

What is the anatomy and function of the "peripheral heart" in the calf?

What is the anatomy and function of the deep veins of the thigh?

What is the anatomy and function of the external iliac vein?

What is the pathophysiology of superior vena cava (SVC) syndrome in deep venous thrombosis (DVT)?

What is the Virchow triad?

What is the role of the Virchow triad in the pathogenesis of deep venous thrombosis (DVT)?

What is the role of thrombosis and fibrinolysis in the pathogenesis of deep venous thrombosis (DVT)?

What is the role of coagulation mechanisms in the pathogenesis of deep venous thrombosis (DVT)?

How do extrinsic and intrinsic coagulation systems operate in the pathogenesis of deep venous thrombosis (DVT)?

What are the 3 anticoagulant mechanisms in the pathophysiology of deep venous thrombosis (DVT)?

What is the role of a disturbance in the coagulation equilibrium in the pathogenesis of deep venous thrombosis (DVT)?

What is the pathogenesis of a thrombus in deep venous thrombosis (DVT)?

Which sites are at increased risk for the development of venous thrombi in deep venous thrombosis (DVT)?

What is the role of chronic venous insufficiency in the pathogenesis of deep venous thrombosis (DVT)?

What is the role of hemodynamic venous insufficiency in the pathogenesis of thrombosis (DVT)?

How common is postthrombotic syndrome (PTS) in patients with symptomatic deep venous thrombosis (DVT)?

What is the incidence of pulmonary embolism (PE) with untreated thrombi?

What are the forms of upper-extremity deep venous thrombosis (DVT)?

What is the pathophysiology of pulmonary embolism (PE) in deep venous thrombosis (DVT)?

What is the role of genetic factors in the etiology of deep venous thrombosis (DVT)?

How are the factors that contribute to deep venous thrombosis (DVT) categorized?

What causes deep venous thrombosis (DVT)?

What is the role of decreased venous blood flow in the etiology of deep venous thrombosis (DVT)?

Which anatomic variants may contribute to venous stasis in deep venous thrombosis (DVT)?

What is the role of a double or duplicated inferior vena cava in the etiology of deep venous thrombosis (DVT)?

What are the common causes of caval thrombosis in deep venous thrombosis (DVT)?

What is the role of a mechanical injury in the etiology of deep venous thrombosis (DVT)?

What is the risk of developing deep venous thrombosis (DVT) with peripherally inserted central catheters (PICCs) compared to central venous catheters (CVCs)?

What is the role of risk factors in determining whether short-term or long-term anticoagulation therapy is warranted for deep venous thrombosis (DVT)?

Which factors increase the risk for venous thromboembolism (VTE)?

What is the most significant risk factor for deep venous thrombosis (DVT)?

How does the risk for deep venous thrombosis (DVT) vary among age groups?

What is the prevalence of malignancy in deep venous thrombosis (DVT)?

How does the risk for postoperative deep venous thrombosis (DVT) vary among types of surgical interventions?

What is the role of the factor V Leiden mutation in the etiology of deep venous thrombosis (DVT)?

What is the treatment for deep venous thrombosis (DVT) in patients with genetic risk factors?

What conditions can induce hypercoagulability and increase the risk for deep venous thrombosis (DVT)?

What are the risk factors for deep venous thrombosis (DVT)?

What is the incidence of deep venous thrombosis (DVT)?

How does the incidence of deep venous thrombosis (DVT) vary among age groups?

Is deep venous thrombosis (DVT) more common in men or women?

What is the racial predilection in deep venous thrombosis (DVT)?

What is the prognosis of deep venous thrombosis (DVT)?

What causes death in patients with deep venous thrombosis (DVT)?

How common is deep venous thrombosis (DVT) manifested as a complication of inflammatory bowel disease (IBD)?

Presentation

What are the signs and symptoms of deep venous thrombosis (DVT)?

What is the presentation of pain in deep venous thrombosis (DVT)?

How frequently do patients with confirmed deep venous thrombosis (DVT) present with signs and symptoms of pulmonary embolism (PE)?

What is efficacy of the clinical diagnosis of deep venous thrombosis (DVT)?

What physical findings are diagnostic of deep venous thrombosis (DVT)?

How accurate is calf pain on dorsiflexion of the foot (Homans sign) for the diagnosis of deep venous thrombosis (DVT)?

How is superficial thrombophlebitis characterized and does it suggest deep venous thrombosis (DVT)?

How is deep venous thrombosis (DVT) detected in patients with pulmonary embolism (PE)?

Which physical findings of discoloration of the lower extremity suggest venous thrombosis?

How common is pulmonary embolism (PE) in patients with deep venous thrombosis (DVT) and what are treatment options?

Which ECG findings suggest pulmonary embolism (PE) in patients with deep venous thrombosis (DVT)?

How is pulmonary embolism (PE) diagnosed?

What increases the risk for paradoxic emboli and deep venous thrombosis (DVT)?

What is the incidence of recurrent deep venous thrombosis (DVT)?

Does hormonal therapy increase the risk for recurrent venous thromboembolism (VTE) in women?

What are the signs and symptoms of postthrombotic syndrome (PTS) in patients with a history of deep venous thrombosis (DVT)?

DDX

How is deep venous thrombosis (DVT) characterized?

When should patients with suspected deep venous thrombosis (DVT) be evaluated for cellulitis?

What conditions should be included in the differential diagnoses for deep venous thrombosis (DVT)?

What are the differential diagnoses for Deep Venous Thrombosis (DVT)?

Workup

What is the role of routine blood tests in the workup of deep venous thrombosis (DVT)?

What are the AAFP and ACP recommendations in the workup of deep venous thrombosis (DVT)?

How is deep venous thrombosis (DVT) diagnosed?

Which tests can be used to exclude upper extremity deep venous thrombosis (UEDVT)?

Which lab tests are performed in the workup of deep venous thrombosis (DVT)?

What is the role of D-dimer testing in the workup of deep venous thrombosis (DVT)?

What is the efficacy of D-dimer testing in the workup of deep venous thrombosis (DVT)?

What is the efficacy of a selective D-dimer testing strategy for the exclusion of deep venous thrombosis (DVT)?

What are the variances in how different D-dimer assays report results for deep venous thrombosis (DVT)?

What is the negative predictive value (NPV) of D-dimer assays in the workup of deep venous thrombosis (DVT)?

What is the role of enzyme-linked immunosorbent assay (ELISA) in the workup of deep venous thrombosis (DVT)?

What is the role of latex-enhanced immunoturbidimetric and immunofiltration assays in the workup of deep venous thrombosis (DVT)?

What is the role of rapid qualitative red blood cell agglutination assay (SimpliRED) in the workup of deep venous thrombosis (DVT)?

What is the role of coagulation studies in the workup of deep venous thrombosis (DVT)?

What is the role of imaging studies in the workup of deep venous thrombosis (DVT)?

What is the criterion standard diagnostic imaging for deep venous thrombosis (DVT)?

What is the role of impedance plethysmography (IPG) in the workup of deep venous thrombosis (DVT)?

What is the role of MRI in the workup of deep venous thrombosis (DVT)?

What is the Wells clinical prediction guide and how is it used in the workup of deep venous thrombosis (DVT)?

Which factors are predictive of venous thromboembolism (VTE)?

Treatment

What are the primary objectives in the treatment of deep venous thrombosis (DVT)?

What are the treatment options for deep venous thrombosis (DVT)?

What is the role of systemic IV thrombolysis in the treatment of deep venous thrombosis (DVT)?

When is thrombolytic therapy indicated in the treatment of deep venous thrombosis (DVT)?

What is the bleeding risk of systemic thrombolysis in the treatment of deep venous thrombosis (DVT)?

When is deep venous thrombosis (DVT) treated in an outpatient setting?

What is the duration of anticoagulant therapy for deep venous thrombosis (DVT)?

What are the exclusion criteria for outpatient treatment of deep venous thrombosis (DVT)?

What is the inpatient treatment and monitoring for deep venous thrombosis (DVT)?

Which specialist consultations may be indicated in the treatment of deep venous thrombosis (DVT)?

What are the risks and benefits of anticoagulant therapy for deep venous thrombosis (DVT)?

What is the first-line therapy for venous thromboembolism (VTE) or pulmonary embolism (PE)?

What are the ACCP recommendations for treatment of venous thromboembolism (VTE)?

Which advances in anticoagulant delivery systems for deep venous thrombosis (DVT) are being investigated?

Which heparin products are used in the treatment of deep venous thrombosis (DVT)?

What is heparin and how is it used in the treatment of deep venous thrombosis (DVT)?

What treatment should be given to patients with recurrent venous thromboembolism (VTE) while on a non-low molecular weight heparin (LMWH)?

What is the role of fondaparinux in the treatment of deep venous thrombosis (DVT)?

Is fondaparinux effective in the treatment of acute venous thromboembolism (VTE)?

Is fondaparinux effective in the treatment of deep venous thrombosis (DVT)?

When is fondaparinux contraindicated in the treatment of deep venous thrombosis (DVT)?

What is the role of rivaroxaban (Xarelto) in the treatment of deep venous thrombosis (DVT)?

What is the efficacy of rivaroxaban (Xarelto) in the treatment of deep venous thrombosis (DVT)?

What is the role of apixaban (Eliquis) in the treatment of deep venous thrombosis (DVT)?

What is the role of dabigatran (Pradaxa) in the treatment of deep venous thrombosis (DVT)?

What is the efficacy of dabigatran (Pradaxa) in the treatment of deep venous thrombosis (DVT)?

What is the role of edoxaban (Savaysa) in the treatment of deep venous thrombosis (DVT)?

What is the efficacy of edoxaban (Savaysa) in the treatment of deep venous thrombosis (DVT)?

What is the role of betrixaban (Bevyxxa) in the treatment of deep venous thrombosis (DVT)?

What is the efficacy of betrixaban (Bevyxxa) in the treatment of deep venous thrombosis (DVT)?

What is the duration of anticoagulation therapy in the treatment of the first episode of deep venous thrombosis (DVT)?

When is cessation of anticoagulant therapy for deep venous thrombosis (DVT) recommended by the ACCP?

What is the efficacy of ultrasonography to determine the duration of anticoagulation therapy for deep venous thrombosis (DVT)?

How should patients with cancer be treated for deep venous thrombosis (DVT)?

When is indefinite therapy indicated for deep venous thrombosis (DVT)?

What is the efficacy of long-term LMWH therapy for deep venous thrombosis (DVT)?

What are possible adverse effects of anticoagulant therapy for deep venous thrombosis (DVT)?

How is hemorrhage treated in patients taking heparin for deep venous thrombosis (DVT)?

What is the treatment of major hemorrhage in patients taking low-molecular-weight heparin (LMWH) for deep venous thrombosis (DVT)?

What factors increase the risk of bleeding in patients taking warfarin for the treatment of deep venous thrombosis (DVT)?

What is the treatment for hemorrhage in patients taking oral warfarin for deep venous thrombosis (DVT)?

What are the possible complications of anticoagulant therapy for deep venous thrombosis (DVT)?

What are the qualities desired in anticoagulants used for treatment of deep venous thrombosis (DVT)?

Which agents have increased the options for anticoagulant therapy for deep venous thrombosis (DVT?

Which drugs are being investigated for possible use in the treatment of deep venous thrombosis (DVT)?

What are the risks of anticoagulation-related major bleeding in patients with deep venous thrombosis (DVT)?

What is the half-life of heparin and when is the anticoagulant effect of therapeutic doses eliminated in patients with deep venous thrombosis (DVT)?

Which agent can be administered for more immediate neutralization of heparin in patients with deep venous thrombosis (DVT)?

Which agents reverse the anticoagulant effect of low molecular weight heparin (LMWH) in patients with deep venous thrombosis (DVT)?

What is the role of vitamin K in the treatment of deep venous thrombosis (DVT)?

What is the role of fresh frozen plasma (FFP) in the treatment of deep venous thrombosis (DVT)?

What is the role of prothrombin complex concentrates (PCCs) in the treatment of deep venous thrombosis (DVT)?

What are the advantages of oral anticoagulant factor Xa or IIa inhibitors over traditional vitamin K antagonists (VKAs) in the treatment of deep venous thrombosis (DVT)?

Which agent is used to treat severe bleeding in patients with deep venous thrombosis (DVT) taking non–vitamin K antagonist oral anticoagulants (NOACs)?

What is the efficacy of idarucizumab (Praxbind) as an anticoagulation reversal agent for deep venous thrombosis (DVT)?

What is the efficacy of andexanet alfa as an anticoagulation reversal agent for deep venous thrombosis (DVT)?

What is the efficacy of aripazine (PER977, ciraparantag) as an anticoagulation reversal agent for deep venous thrombosis (DVT)?

What are the adverse effects of thrombolytic medications to lyse deep venous thrombosis (DVT)?

Which factors increase the bleeding risk for thrombolytic medication used in the treatment of deep venous thrombosis (DVT)?

What is the role of percutaneous transcatheter treatment in deep venous thrombosis (DVT)?

What are the indications and contraindications for endovascular intervention for deep venous thrombosis (DVT)?

Which devices are an adjunct therapy to catheter-directed thrombolysis for deep venous thrombosis (DVT)?

What is the role of surgical thrombectomy in the treatment of deep venous thrombosis (DVT)?

What is the protocol for surgical thrombectomy?

What is used to reduce the risk of embolization during a surgical thrombectomy for deep venous thrombosis (DVT)?

What is the benefit of creating an arteriovenous fistula during surgical thrombectomy for deep venous thrombosis (DVT)?

What are the rethrombosis rates in surgical thrombectomy for deep venous thrombosis (DVT)?

When are IVC filters contraindicated in the treatment of deep venous thrombosis (DVT)?

What is the role of IVC filters in the treatment of deep venous thrombosis (DVT)?

What is the efficacy of adding an IVC filter to anticoagulation in the treatment of deep venous thrombosis (DVT)?

When is an IVC filter a useful adjunct in the treatment of deep venous thrombosis (DVT)?

What is the ideal vena cava filter for treatment of deep venous thrombosis (DVT)?

Which techniques are used for the placement of IVC filters in the treatment of deep venous thrombosis (DVT)?

What are the AHA recommendations for use of IVC filters in the treatment of deep venous thrombosis (DVT)?

What are relative contraindications for IVC filters in the treatment of deep venous thrombosis (DVT)?

What is the role of percutaneously placed bioprosthetic venous valves in the treatment of deep venous thrombosis (DVT)?

What is the role of elastic compression stockings (ECS) in the treatment of deep venous thrombosis (DVT)?

What is the efficacy of elastic compression stockings (ECS) for the prevention of postthrombotic syndrome (PTS) in patients with deep venous thrombosis (DVT)?

How much has the use of graduated elastic compression stockings (ECS) reduced the incidence of postthrombotic syndrome (PTS) in patients with deep venous thrombosis (DVT)?

What are the ACCP recommendations for the use of elastic compression stockings (ECS) in patients with deep venous thrombosis (DVT)?

What is the role of ambulation in the therapy of deep venous thrombosis (DVT)?

What is the role of walking exercise in the treatment of deep venous thrombosis (DVT)?

When is ambulation used in the treatment of deep venous thrombosis (DVT)?

What are the ACCP recommendations for the use of ambulation in deep venous thrombosis (DVT) treatment?

When is superficial thrombophlebitis associated with deep venous thrombosis (DVT)?

How is superficial thrombophlebitis treated?

What is axillary and subclavian vein thrombosis (Paget–von Schrötter syndrome)?

How is axillary and subclavian vein thrombosis (Paget–von Schrötter syndrome) diagnosed?

What are the treatment options for axillary and subclavian vein thrombosis (Paget–von Schrötter syndrome)?

When is surgery indicated for axillary and subclavian vein thrombosis (Paget–von Schrötter syndrome)?

What are the options for primary prophylaxis of deep venous thrombosis (DVT)?

What is the efficacy of pneumatic compression in preventing deep venous thrombosis (DVT) in patients undergoing cardiac surgery or neurosurgery?

What is the effect of timing and duration of prophylactic agents on the development of deep venous thrombosis (DVT)?

Which factors increase the risk for deep venous thrombosis (DVT) and what are the possible complications?

Medications

What are the goals of pharmacotherapy for deep venous thrombosis (DVT)?

Which medications in the drug class Anticoagulants are used in the treatment of Deep Venous Thrombosis (DVT)?

Which medications in the drug class Low Molecular Weight Heparins are used in the treatment of Deep Venous Thrombosis (DVT)?

Which medications in the drug class Vitamin K Antagonists are used in the treatment of Deep Venous Thrombosis (DVT)?

Which medications in the drug class Thrombolytics are used in the treatment of Deep Venous Thrombosis (DVT)?