WELCOME

1. WELCOME

2. THROMBOPHLEBITIS

3. Thrombophlebitis • Formation of a venous clot depends on the presence of of at least of one of Virchow’s triad factors -venous stasis -injury to vessel wall -hypercoagulable state

4. SIGNS AND SYMPTOMS • pain in the part of the body affected • skin redness or inflammation (not always present) • swelling (edema) of the extremities (ankle and foot).

6. CAUSES • Thrombophlebitis is related to a thrombus in the vein. Risk factors include prolonged sitting and disorders related to blood clotting • Specific disorders associated with thrombophlebitis include superficial thrombophlebitis (affects veins near the skin surface) and deep venous thrombosis (affects deeper, larger veins)

7. Clinical risk factors for deep vein thrombosis • Trauma, travel • Hypercoagulable, hormone replacement • Recreational drugs(IV drugs) • Old (age >60y) • Malignancy • Obesity, obstetrics • Surgery, smoking • Immobilization • Birth control, blood group A • Sickness

8. Pathophysiology • Most common cause of hereditary hemophilia is factor V Leiden • Thrombi usually form at the venous cusps of deep veins where altered or static blood flow causes clot formation • Alternatively, clots form from intimaldefects • Clots are composed from fibrin, red cells and platelets and cause partial/complete obstruction of vein

9. Pathophysiology • Postphlebiticsyndrome (PPS) may develop after the resolution of a DVT • PPS is due valvular incompetence, persistent outflow obstruction and abnormal microcirculation.

10. Superficial Thrombophlebitis • Thrombosis can occur in any superficial vein primarily the saphenous vein and its tributaries • Local pain, redness, and tenderness are characteristic findings. • Mild cases can be treated with warm compresses, analgesia and elastic supports • Severe cases can be debilitating and should be managed by bed rest, elevation of extremity, support stockings, and analgesia. • Antibiotics and anticoagulants are useful in septic thrombophlebitis

11. Deep Vein Thrombosis • Clinical exam is unreliable for detection or exclusion of a DVT • Pain, redness, swelling, and warmth are present in less than half the patients with confirmed DVT. • Pain in calf with dorsiflexion of ankle with the leg straight (Homan’s sign) is unreliable

12. Deep Vein Thrombosis • the leg is white due to arterial spasm secondary to massive iliofemoral thrombosis, often mistaken for arterial occlusion. • PPS can be difficult to differentiate from recurrent DVT due to pain, swelling and ulceration of the skin. • Up to to one third of the patients with DVT can develop PPS.

15. Deep Vein Thrombosis-Diagnosis • All patients with any signs or symptoms suggestive DVT should undergo an objective diagnostic evaluation • Venography was the historical “gold standard” for detection of DVT with 100% sensitivity and specificity but it is invasive and can cause contrast-related reactions, phlebitis and DVT .

16. Axillary and Subclavian Vein thrombosis • 2-4% of DVTs occur in axillary or subclavian vein • Risks include recent central venous catheters or pacemakers, IV drug use, malignancy, hypercoagulable states and excessive or unusual exercise, chronic compression(cervical rib, scalene or web) • Treatment includes anticoagulation alone or preceded by thrombolysis.

17. Pelvic Vein Thrombosis • Usually it’s an extension of a clot from the femoral vein. • An isolated pelvic vein thrombosis is rare and can be a complication in the postpartum period, after pelvic surgery or trauma. • Septic pelvic vein thrombophlebitis is a life-threatening condition after post-partum endometritis and is usually diagnosed with CT or MRI.

19. COMPLICATIONS • The most serious complication occurs when the blood clot dislodges, traveling through the heart and occluding the dense capillarynetwork of the lungs; this is a pulmonary embolismwhich can be potentially life threatening

20. Treatment • Bed rest, leg elevation and elastic stockings are of unproven benefit in the management of DVT. • Aggressive anticoagulation will prevent extension of the clot. • Early ambulation after adequate anticoagulation is a safe approach • Primary objective of treating DVT is the prevention of pulmonary embolus

21. Treatment • Medications analgesics (pain medications) • anticoagulantse.gwarfarin or heparin to prevent new clot formation • thrombolytics to dissolve an existing clot such as intravenous streptokinase. • nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen to reduce pain and inflammation • antibiotics (if infection is present) selection will usually depend with the causative agent. • Support stockings and wraps to reduce discomfort

22. Treatment • In pregnant pt who cannot have heparin, danaproid should be used. • Warfarin is contraindicated in pregnancy, active bleeding, recent major surgery (thoracoabdominal, nervous system, spine, eye)

23. The patient may be advised to do the following • Elevate the affected area to reduce swelling. • Keep pressure off of the area to reduce pain and decrease the risk of further damage. • Apply moist heat to reduce inflammation and pain. • Surgical removal, stripping, or bypass of the vein is rarely needed but may be recommended in some situations.

25. THANK YOU