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DEEP VENOUS THROMBOSIS

Definition . Deep vein thrombosis is the formation of thrombus in one of the deep veins of the body, usually in the leg . www.icareunit.com. ETIOLOGY . DVT ususally originates in the lower extremity venous level ,starting at the calf vein level and progressing proximally to involve popliteal ,femo

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DEEP VENOUS THROMBOSIS

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    1. DEEP VENOUS THROMBOSIS Done by : As3d al-rwashdeh 7ussam al-5waldeh www.icareunit.com

    2. Definition Deep vein thrombosis is the formation of thrombus in one of the deep veins of the body, usually in the leg www.icareunit.com

    3. ETIOLOGY DVT ususally originates in the lower extremity venous level ,starting at the calf vein level and progressing proximally to involve popliteal ,femoral ,or iliac system. .80 -90 % pulmonary emboli originates here . www.icareunit.com

    4. Virchow triad More than 100 years ago, Virchow described a triad of factors of venous stasis endothelial damage hypercoagulable state www.icareunit.com

    5. Venous stasis prolonged bed rest (4 days or more) A cast on the leg Limb paralysis from stroke or spinal cord injury extended travel in a vehicle www.icareunit.com

    6. Hypercoagulability Surgery and trauma responsible for up to 40% of all thromboembolic disease Malignancy Increased estrogen (due to a fall in protein ‘S) occurs during all stages of pregnancy the first three months postpartum, after elective abortion, and during treatment with oral contraceptive pills www.icareunit.com

    7. Inherited disorders of coagulation deficiencies of protein S protein C antithrombin III. www.icareunit.com

    8. Acquired disorders of coagulation nephrotic syndrome results in urinary loss of antithrombin III, this diagnosis should be considered in children presenting with thromboembolic disease Antiphospholipid antibodies accelerate coagulation and include the lupus anticoagulant and anticardiolipin antibodies. www.icareunit.com

    9. Inflammatory processes, such as systemic lupus erythematosus (SLE), sickle cell disease inflammatory bowel disease (IBD), also predispose to thrombosis, presumably due to hypercoagulability www.icareunit.com

    10. Endothelial Injury Trauma surgery invasive procedure may disrupt venous integrity Iatrogenic causes of venous thrombosis are increasing due to the widespread use of central venous catheters, particularly subclavian and internal jugular lines. These lines are an important cause of upper extremity DVT, particularly in children. www.icareunit.com

    11. Clinical Pathophysiology The nidus for thrombus is often an intimal defect When a clot forms on an intimal defect, the coagulation cascade promotes clot growth proximally. (rarely thrombus can extend from the superficial veins into the deep system from which it can embolize to the lungs). www.icareunit.com

    12. Opposing the coagulation cascade is the endogenous fibrinolytic system. After the thrombus organizes or dissolves, most veins will recanalize in several weeks. Residual thrombus retract as fibroblasts and capillary development lead to intimal thickening. Venous hypertension and residual thrombus may destroy valves, leading to the postphlebitic syndrome, which develops within 5-10 years www.icareunit.com

    13. Edema, sclerosis, and ulceration characterize this syndrome, which develops in 40-80% of patients with DVT. patients also can suffer exacerbations of swelling and pain, probably as a result of venous dilatation and hypertension      Pulmonary embolism (PE) is a serious complication of DVT. Many episodes of pulmonary embolism go unrecognized, and at least 40% of patients with DVT have clinically silent PE on VQ scanning www.icareunit.com

    14. Risk factors Past DVT Immobilization Pregnancy OCP and HRT Trauma Obesity Age Sepsis Cancer Diseases that alter blood viscosity (sickle cell, polycythemia, multiple myeloma) www.icareunit.com

    15. www.icareunit.com

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