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Management of Deep Vein Thrombosis in the Emergency Department

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Points and Pearls Excerpt

  • Pathophysiology for deep vein thrombosis (DVT) is related to the Virchow triad: venous stasis, endothelial vascular injury, and hypercoagulability.
  • Unprovoked DVT can be due to genetic causes, such as having a non-O blood group, factor V Leiden mutation, prothrombin gene mutation, or protein C and protein S deficiency.
  • Provoked DVT can result as a complication of cancer, oral contraceptive use, pregnancy, long-distance travel, surgery, or trauma.
  • Classic signs and symptoms of DVT include pain, swelling, discoloration, heaviness, and cramping sensation.
  • The Wells criteria, validated and endorsed by the American College of Emergency Physicians (ACEP), stratifies patients as low, moderate, or high pre-test probability of having a DVT.

Most Important References

  • White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I4-8. (Review) DOI: 10.1161/01.CIR.0000078468.11849.66
  • Goodacre S, Sutton AJ, Sampson FC. Meta-analysis: the value of clinical assessment in the diagnosis of deep venous thrombosis. Ann Intern Med. 2005;143(2):129-139. (Meta-analysis; 51 studies) DOI: 10.7326/0003-4819-143-2-200507190-00012
  • American College of Emergency Physicians ACEP Clinical Policies Committee, ACEP Clinical Policies Subcommittee on Suspected Lower-Extremity Deep Venous Thrombosis. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected lower-extremity deep venous thrombosis. Ann Emerg Med. 2003;42(1):124-135. (Clinical policy) DOI: 10.1067/mem.2003.181
  • Bates SM, Jaeschke R, Stevens SM, et al. Diagnosis of DVT: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e351S-e418S. (Guideline) DOI: 10.1378/chest.11-2299
  • Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795-1798. (Prospective study; 593 patients) DOI: 10.1016/S0140-6736(9 7)08140-3
  • Wells PS, Owen C, Doucette S, et al. Does this patient have deep vein thrombosis? JAMA. 2006;295(2):199-207. (Meta-analysis; 14 studies, 8000 patients) DOI: 10.1001/jama.295.2.199
  • Wolf SJ, Hahn SA, Nentwich LM, et al. Clinical Policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected acute venous thromboembolic disease. Ann Emerg Med. 2018;71(5):e59-e109. (Clinical Policy) DOI: 10.1016/j.annemergmed.2018.03.006
  • Kearon C, Akl EA, Omelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. CHEST. 2016;149(2):315-352. (Guideline) DOI: 10.1016/j.chest.2015.11.026
  • Hanley M, Steigner ML, Ahmed O, et al. ACR Appropriateness Criteria®: suspected lower extremity deep vein thrombosis. J Am Coll Radiol. 2018;15(11):S413-S417. (Guideline) DOI: 10.1016/j.jacr.2018.09.028
  • Othieno R, Okpo E, Forster R. Home versus in-patient treatment for deep vein thrombosis. Cochrane Database Syst Rev. 2018;1:CD003076. (Cochrane review; 7 randomized controlled trials, 1839 patients) DOI: 10.1002/14651858.CD003 076.pub2
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Publication Information
Authors

Shane R. Sergent, DO, FAAEM, FACOEP, FAWM, RDMS; Michael Galuska, MD, FACEP, FAAEM; John Ashurst, DO, MSc, FACEP, FACOEP

Peer Reviewed By

Jennifer Maccagnano, DO, FACEP, FACOEP; Laura Melville, MD, MS

Publication Date

October 1, 2020

CME Expiration Date

November 2, 2023

CME Credits

4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.

Pub Med ID: 33001594

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CME Information

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