Management of Deep Vein Thrombosis in the Emergency Department

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

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• 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
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• 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
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