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

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.