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Diagnosis and treatment of deep-vein thrombosis

From the Departments of Medicine (Scarvelis, Wells) and of Community Medicine and Epidemiology (Wells), the Division of Hematology (Scarvelis, Wells), and the Ottawa Health Research Institute (Scarvelis, Wells), University of Ottawa, Ottawa, Ont.

Correspondence to: Dr. Dimitrios Scarvelis, Division of Hematology, The Ottawa Hospital, Rm. 462, 737 Parkdale Ave., Ottawa ON K1Y 1J8; fax 613 761-4840; dscarvelis{at}ottawahospital.on.ca

Abstract

Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. The approach to the diagnosis of DVT has evolved over the years. Currently an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasound imaging allows for safe and convenient investigation of suspected lower-extremity thrombosis. Patients with low pretest probability and a negative D-dimer test result can have proximal DVT excluded without the need for diagnostic imaging. The mainstay of treatment of DVT is anticoagulation therapy, whereas interventions such as thrombolysis and placement of inferior vena cava filters are reserved for special situations. The use of low-molecular-weight heparin allows for outpatient management of most patients with DVT. The duration of anticoagulation therapy depends on whether the primary event was idiopathic or secondary to a transient risk factor. More research is required to optimally define the factors that predict an increased risk of recurrent DVT to determine which patients can benefit from extended anticoagulant therapy.

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