DEEP VEIN THROMBOSIS

DR. dr. Idar Mappangara Sp.PD, Sp.JP(K)

INTRODUCTION
DEFINITION
DVT is the formation of blood
clots in the deep vein
ETIOLOGY
Statis

hypercoagulability

Endothelial damage
RISK FACTOR
Statis Hypercoagubility Endhotelial damage

• Pregnancy • Increasing Age • Previous DVT

• Stroke • Estrogen theraphy • Smoking
• Surgery within the • Cancer theraphy • Varicose vein
last 3 months • History of VTE • Central venous
• Chronic heart disease • Thrombophilia catheterization
• Obesity
PATHOGENESIS
STATIS
Systemic Local

Increased blood Accumulation of Hypoxia of valve cusp

Immobilization pools clotting factors in
viscosity blood in calf venous produces tissue factor
venous of calf and active coagulation

THROMBUS
PATHOGENESIS
ENDOTHELIAL DAMAGE

Exposure of tissue
Activation by
factor/subendhothelial Release PAI-1
inflammatory cytokines
matrix

THROMBUS
PATHOGENESIS
HYPERCUAGUBILITY

Coagulation
Inflamation cascade
activation

THROMBUS
 CLINICAL SYMPTOMS
• Calf pain
• Tenderness
• Swelling
• Redness
• Homan’s sign
 DIAGNOSIS

MAZZOLAI LUCIA, DIAGNOSIS AND MANAGEMENT ACUTE dvt

DIAGNOSIS
VENOUS ULTRASOUND

Vein Incompressibility

Direct thrombus imaging with vein enlargement

THROMBUS
VENOUS ULTRASOUND
Abnormal color dopler flow
D-Dimer
• Fibrin Normal D-DIMER < 500 ng/dl
degradation
product elevated
in active
thrombosis
• Negative test can
help exclude VTE
THERAPHY
Stop developing • Anticoagulan theraphy
thrombus

Prevent • Anticoagulan theraphy

complications • Wound care

Limitting • Bedrest
• Raise the position of the foot
progressive limb • Compression stocking
swelling
THERAPHY
Unfractionated
heparin

LMWH

Pharmacologi
warfarin
theraphy

Anti factor Xa

Direct thrombin
inhibitor
THERAPY

UFH may be preferable in patients with severe renal failure,

unstable renal function or high bleeding risk.
THERAPHY
Non farmacologis theraphy
1. Bedrest
2. Raise the position of the foot
3. Compression stocking
THERAPHY

Surgical thrombectomy
theraphy
PROGNOSIS
Without adequate treatmentlower extremity DVT has a 3% risk of
fatal PE
death due to upper extremity DVT is very rare.
Risk of recurrent DVT is lowest for patients with transient risk factors
(eg, surgery, trauma, temporary immobility)
Greatest for patients with persistent risk factors (eg,
cancer)idiopathic DVT, or incomplete resolution of past DVT (residual
thrombus).