See also:
Benign edema of pregnancy
Joint/limb pain Ddx
Hx
Recently started OCPs for DUB
Prophylaxis
Heparin
Hospital & surgical patients
Enoxaparin (Lovenox)
Hospital & surgical patients
Pregnant
High risk patients traveling (take 1 dose)
Sx (typically some combination of):
Fever
Unilateral leg pain
Unilateral swelling
Redness
Calf tenderness
PE
Homan's sign (pain in calf when foot is dorsiflexed--not very sensitive or specific)
Workup
Calculate Wells score
If low then D-dimer
If high then
Venous ultrasound (94% sens, 94% spec for proximal DVT, only 63% sens for distal DVT); OR
MRV (magnetic resonance venography)
Doppler U/S--affected leg
CBC
CK
D-dimer
PT/PTT, fibrinogen
XR--affected leg
Tx
Most pts can be safely tx with LMWH as outpatients, unless they have PE (pts w/PE should generally be tx inpatient).
No difference in outcomes btwn inpatient tx w/unfractionated heparin vs outpatient w/LMWH, and significant cost savings for the outpatients w/LMWH
Graduated compression stockings should be started within 1 month and continued for a year to prevent post thrombotic syndrome
Warfarin should be started concomitantly with heparrin and titrated to therapeutic goal of INR 2.0-3.0
Mgmt, practical considerations
Need u/s for dx. If unable to get u/s immediately then treat empirically e.g. with Xarelto
