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Clots

July 2010

FocusClots

Deep vein thrombosis

Risks and diagnosis

Volume 39, No.7, July 2010 Pages 468-474

Wai Khoon Ho MMedSc, FRACP, FRCPA, is Consultant Haematologist, Department of Haematology, Austin Health, Melbourne, Victoria.

Background

Venous thromboembolism, comprising deep vein thrombosis (DVT) and pulmonary embolism, is common in Australia and is associated with high morbidity.

Objective

This article provides a summary of the risk factors for DVT of the lower limb and discusses the diagnosis of the condition using a diagnostic algorithm incorporating clinical assessment, D-dimer testing and imaging studies. It also briefly reviews the clinical significance of isolated distal lower limb DVT and superficial vein thrombosis.

Discussion

Many conditions in the lower limb mimic DVT. Diagnosing DVT on clinical grounds without objective testing is unreliable. Patients incorrectly diagnosed as having DVT may be subjected to unnecessary anticoagulation and its associated risks of bleeding. In contrast, there is a risk of thrombus extension and embolisation when DVT is missed or inappropriately treated.

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism (PE), is the third commonest vascular disorder in Caucasian populations.1 In Australia, DVT alone (without concomitant PE) affects 52 persons per 100 000 annually.2 Timely management of DVT is important as it is a common cause of morbidity. Thromboses of the deep veins in the upper limbs and ‘unusual sites’, such as mesenteric veins, constitute less than 10% of DVT cases.2 As they are uncommon, this article focuses only on the risks and diagnosis of lower limb DVT.

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Correspondence afp@racgp.org.au

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Topics

Medications & therapeutics Preventive medicine & risk factors

Type

Focus