- See:
-
Coag Pathway
-
Pulmonary Embolus
-
DVT in Hip Frx and Surgery:
-
DVT Following THR:
-
DVT Following TKR:
-
DVT / PE arising from Trauma and Fractures
- Diagnostic Studies:
-
work up for DVT:
-
ABG / pulse ox;
-
Coag Labs: (
PT/PTT,
Fibrinogen, and
CBC (for HCT & platlet count));
-
EKG and CXR (if PE is suspected)
- D-dimer:
- ref:
Evaluation of D-Dimer in the Diagnosis of Suspected Deep-Vein Thrombosis
-
ultrasound:
-
MRI:
- may emerge as the new gold standard for diagnosis of DVT;
- can diagnosis pelvic DVT, and can be used to diagnose DVT in patients who have femoral or tibial frx;
-
impedence phlebography: inaccurate and difficult to perform;
-
venography:
- remains the gold standard for diagnosis of DVT;
- venograms should meet at least one of the following direct or indirect criteria:
- a constant defect in filling seen on two views;
- an abrupt discontinuation of visible filling at a constant site in the vein;
- the absence of filling in the entire deep-vein system (without external compression), w/ or w/o venous flow through collaterals;
-
disadvantages:
- some have questioned whether venography might actually cause DVT to form due to vessel
inflammation from the contrast dye (estimated that 1-3% of venograms lead to DVT);
- this complication is now less common with newer contrast dye;
- systemic reactions;
- skin necrosis from extravasation from dye;
- inability to diagnose pelvic venous thrombi;
- cannot be used when there is ipsilateral femoral or tibial frx;
References
Comparison of Enoxaparin and Warfarin for the Prevention of Venous Thromboembolic Disease After Total Hip Arthroplasty. Evaluation During Hospitalization and Three Months After Discharge
CW Colwell et al JBJS July 1999, Vol 81-A, No 7.
Finding the right fit: Effective thrombosis risk stratification in orthopeadic patients.
JI Arcelus MD PhD et al.
Orthopedics.
Jun 2000. Vol 23. No 6. p 633.
