← Diagnosis and Management Guides
Deep Vein Thrombosis
Key considerations: Pulmonary embolism, Phlegmasia cerulea dolens, Compartment syndrome
Cannot miss
- Pulmonary embolism
- Phlegmasia cerulea dolens
- Compartment syndrome
Likely diagnoses
- DVT
- Cellulitis
- Baker cyst rupture
- Superficial thrombophlebitis
Red flags
- Massive leg swelling
- Cyanotic limb
- Chest pain/dyspnea
Workup
- history: Unilateral leg swelling, pain, immobility, recent surgery, cancer history; exam: Calf swelling >3cm asymmetry, Homan sign (unreliable), pitting edema; labs: D-dimer (if low pretest probability); CBC, BMP, coags; imaging: Compression ultrasound of lower extremity; bedside: Wells DVT score
Management
- immediate: Anticoagulation: rivaroxaban, apixaban, or LMWH + warfarin; general: Duration: 3 months minimum, longer if unprovoked or recurrent; IVC filter only if anticoagulation contraindicated
Disposition
- admit: Phlegmasia, iliofemoral DVT requiring catheter-directed therapy; discharge: Most uncomplicated DVTs can be treated outpatient; consults: Vascular surgery for phlegmasia, hematology for recurrent VTE
Clinical pearls
- Negative D-dimer with low pretest probability effectively rules out DVT
- Cancer screening reasonable after first unprovoked DVT
Source and review
- ASH VTE Guidelines 2020. Last reviewed: 2024-11-01