0071643192.pdf

TABLE 2.30. Clinical Considerations in the Treatment of DVT

Proximal DVT

Immediate anticoagulation with heparin and warfarin until INR therapeutic

Massive DVT

Vascular surgery consult for thrombectomy

Consider thrombolysis

Consider IVC filter placement

Isolated calf vein thrombosis

These veins have a low risk for embolization but

At least 25% will propagate proximally, where they mayembolize

Options include anticoagulation (for high-risk patients) or

ASA and follow-up ultrasound in 3—7 days

Proximal greater saphenous vein clot

Too close to the deep system for comfort!

Anticoagulate

Recurrent DVT on adequate warfarin

Add heparin

Indication for IVC filter placement

Propagation of DVT on adequate warfarin and heparin

Indication for IVC filter placement

COMPLICATIONS

■ PE
■ Chronic venous insufficiency
■ SVC syndrome (upper extremity clot)
■ From therapy: Heparin-induced thrombocytopenia, warfarin skin necrosis,
bleeding
■ Post-phlebitic syndrome

A 40-year-old female 1 week status post mastectomy presents with mild

R-sided pleuritic chest pain and dyspnea. Her initial BP is 124/72, HR is 122,

O 2 saturation is 90% on room air, and temperature is 101ºF. Exam reveals

equal breath sounds with no rales or rhonchi. There is no redness or swelling over

the chest wall. There is no swelling in the legs. What is the study of choice in this

patient?

CT angiogram of chest to evaluate for PE. Because this patient has a high

pretest probability for PE, a D-dimer is not indicated. CT can also detect abscess

or pneumonia in this patient.

CARDIOVASCULAR EMERGENCIES