Deep vein thrombosis: update on diagnosis and management

Abstract

Summary Diagnosis of deep vein thrombosis (DVT) requires a multifaceted approach that includes clinical assessment, evaluation of pre‐test probability, and objective diagnostic testing. Common symptoms and signs of DVT are pain, swelling, erythema and dilated veins in the affected limb. The pre‐test probability of DVT can be assessed using a clinical decision rule that stratifies DVT into “unlikely” or “likely”. If DVT is “unlikely”, refer for D‐dimer test. If the D‐dimer level is normal, DVT can be excluded; if the D‐dimer level is increased, refer for compression ultrasound. If DVT is “likely”, refer for compression ultrasound. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post‐thrombotic syndrome and pulmonary embolism. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. DOACs are the preferred treatment for DVT because they are at least as effective, safer and more convenient than warfarin. DOACs may require dose reduction or avoidance in patients with renal dysfunction, and should be avoided in pregnancy. Recent evidence shows that DVT in patients with cancer may be treated with edoxaban (after discontinuation of 5 days of initial heparin or low molecular weight heparin [LMWH]) or rivaroxaban if patients prefer not to have daily injections of LMWH, but the risk of gastrointestinal bleeding is higher with DOACs than with LMWH in patients with gastrointestinal cancer.

Analysis of Effectiveness, Safety, and Bleeding Related to Rivaroxaban in Elderly Patients

“…Warfarin and low-molecular-weight heparin are the traditional medications for treatment of thromboembolic diseases, 3 , 4 but there are many disadvantages, including the need for regular coagulation monitoring associated with some food-drug interactions, which can aggravate drug compliance. 5 Low-molecular-weight heparin is injected, and patients’ compliance is poor.…”

Development and validation of an informative manual on venous thromboembolism for the lay population

“…Thrombi can detach from the vessel walls and travel through the circulation, obstructing the pulmonary vessels. (1)(2)(3)(4) Approximately 10 million people in the world are affected by the disease. (2) More than 500 thousand deaths in Europe and over 300 thousand in the United States occur annually due to VTE.…”

“…Thrombi can detach from the vessel walls and travel through the circulation, obstructing the pulmonary vessels. ( 1 - 4 )…”

Evaluation of the role of Nrf2/Keap1 pathway‑associated novel mutations and gene expression on antioxidant status in patients with deep vein thrombosis

“…The pathogenesis of DVT involves endothelial dysfunction (endothelial damage-dysfunction), hypercoagulability and stasis (slow blood flow). These mechanisms may lead to venous obstruction and thromboembolism, resulting in serious consequences ranging from post-thrombotic syndrome to pulmonary thromboembolism (6,7). Oxidative stress is a key factor that contributes to the pathogenesis of numerous cardiovascular diseases, including atherosclerosis, hypertension, heart failure, ischemia/reperfusion injury and thrombosis (8)(9)(10)(11).…”