Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Feb 12 2023

Deep Vein Thrombosis

  • Introduction
    • Introduction
      • procedures associated with greater frequency of DVT
        • spine fracture with paralysis
        • elective total knee arthroplasty
          • 2-3X greater rate of DVT than THA
        • elective total hip arthroplasty
          • no increased risk in patients with Factor V Leiden
        • hip fracture
        • polytrauma
      • based on AAOS review, the rate of DVT does not correlate with PE or death following THA or TKA
  • Presentation
    • Symptoms
      • pain in leg
    • Physical exam
      • often more helpful than imaging
        • pain and swelling
        • Homan's sign is not very specific
  • Imaging
    • Imaging
      • venography is gold standard
      • for proximal DVTs (proximal to trifurcation)
        • venous duplex ultrasound is 96% sensitive, 97% specific; operator dependent
          • routine duplex screening is not recommended
        • plethysmography is 75% sensitive, 90% specific
        • CT is 90% sensitive, 95% specific
  • Studies
    • D-Dimer testing
      • sensitive marker for VTE and excludes VTE without the need for further testing among patients with of low clinical probability of PE
      • not helpful post-injury or surgery
      • levels > 500 ng/mL suggest the presence of PE
  • Treatment
    • Nonoperative
      • heparin therapy followed by oral anticoagulation
        • indications
          • postoperative DVT above knee
          • treatment for DVT below knee is controversial
        • medications
          • direct oral anticoagulants, including the direct thrombin inhibitor dabigatran and the factor Xa inhibitors rivaroxaban, apixiban, and edoxaban, are now recommended by the 2016 American College of Chest Physicians and 2014 and 2017 European Society of Cardiology guidelines for both DVT and PE
        • duration
          • in patients with VTE provoked by surgery, the risk of recurrence after treatment is low and anticoagulation is recommended for only 3 months
          • for patients with an unprovoked DVT, there is a high risk of recurrence and anticoagulation should be continued indefinitely unless bleeding risk is high
    • Operative
      • vena cava filter placement
        • indications
          • preoperative identification of DVT in a patient with lower extremity or pelvic trauma who is high risk for DVT development
          • see anticoagulation
        • catheter-directed thrombolysis
          • indications
            • indicated as initial treatment recommended only for patients with threatened limb loss
  • Complications
    • Postthrombotic syndrome: chronic venous insufficiency
      • venous HTN
      • chronic skin issues (swelling, pain, pigmentation, ulceration, induration)
      • recurrent DVT (4-8x higher after first DVT)
flashcard locked
Create a free account or log in to see the cards.
Question
1 of 4
In scope icon L 4
QID 219567 (Type "219567" in App Search)
A 28-year-old male presents to the clinic for evaluation of chronic left wrist pain. The patient reports that eight months ago he fell while playing basketball and immediately experienced wrist pain. He subsequently presented to urgent care, where orthogonal views of the wrist were obtained, but no fracture was demonstrated. He was given a wrist splint which he intermittently used for four weeks. Despite this, he continued to experience a dull ache since the event, which has been slowly worsening. On examination, snuffbox tenderness is noted. Radiographs are obtained as shown in Figures A-C. He is subsequently sent for an MRI, as shown in Figure D. Which of the following is true concerning managing this patient's injury?
  • A
  • B
  • C
  • D

The dorsal approach is most appropriate to correct the humpback deformity

15%

129/879

The volar approach should be avoided to mitigate risk of devascularization

11%

99/879

Continued immobilization would likely result in fracture union

3%

29/879

Vascularized autograft has similar union rates in comparison to non-vascularized autograft

54%

479/879

Iliac crest autograft has shown superior union rates in comparison to distal radius autograft

15%

133/879

  • A
  • B
  • C
  • D

Select Answer to see Preferred Response

Basic Science⎪ Deep Vein Thrombosis
  • Basic Science
  • - Deep Vein Thrombosis
4:48 min
12/28/2020
547 plays
5.0
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
(2)
Private Note

Add Colleague
Lab Values
Calculator
Content analytics