24th July 2024

DVT

Clinical features of DVT

Presentation is typically with an acutely swollen, erythematous leg. Differentials include cellulitis or knee bursitis.

Risk factors include: recent immobilisation, recent surgery, dehydration, active malignancy, pro-thrombotic conditions, trauma, intrinsic compression of veins, Covid-19, medications such as the oral contraceptive pill, nephrotic syndrome, obesity and inflammatory bowel disease. A risk factor history must be taken for anyone with suspected VTE.

If there is doubt about the diagnosis, the Well’s score for DVT can be used (see online calculators, e.g. MDCalc.com). With a low score, D-dimer should be performed. If negative, no further investigations are required; if positive, US Doppler should be performed. With a higher Well’s score, US Doppler should be performed directly.

Management of DVT

Management is predominantly with DOACs, but warfarin and LMWH are also used. The duration of treatment is determined by whether the clot was provoked (typically treated for three months) or unprovoked. For VTE with no obvious cause, treatment must be continued for a minimum of 6 months and can be indefinite.