Deep venous thrombosis
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms.
Deep venous thrombosis
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are manifestations of a single disease entity, namely, venous thromboembolism (VTE). The earliest known reference to peripheral venous disease is found on the Eber papyrus, which dates from 1550 BC and documents the potentially fatal hemorrhage that may ensue from surgery on varicose veins. In 1644, Schenk first observed venous thrombosis when he described an occlusion in the inferior vena cava. In 1846, Virchow recognized the association between venous thrombosis in the legs and PE.
DVT is the presence of coagulated blood, a thrombus, in one of the deep venous conduits that return blood to the heart. The clinical conundrum is that symptoms (pain and swelling) are often nonspecific or absent. However, if left untreated, the thrombus may become fragmented or dislodged and migrate to obstruct the arterial supply to the lung, causing potentially life-threatening PE See the images below.
Over a century ago, Rudolf Virchow described 3 factors that are critically important in the development of venous thrombosis: (1) venous stasis, (2) activation of blood coagulation, and (3) vein damage. These factors have come to be known as the Virchow triad.
Venous stasis can occur as a result of anything that slows or obstructs the flow of venous blood. This results in an increase in viscosity and the formation of microthrombi, which are not washed away by fluid movement; the thrombus that forms may then grow and propagate. Endothelial (intimal) damage in the blood vessel may be intrinsic or secondary to external trauma. It may result from accidental injury or surgical insult. A hypercoagulable state can occur due to a biochemical imbalance between circulating factors. This may result from an increase in circulating tissue activation factor, combined with a decrease in circulating plasma antithrombin and fibrinolysins.
Over time, refinements have been made in the description of these factors and their relative importance to the development of venous thrombosis. The origin of venous thrombosis is frequently multifactorial, with components of the Virchow triad assuming variable importance in individual patients, but the end result is early thrombus interaction with the endothelium. This interaction stimulates local cytokine production and facilitates leukocyte adhesion to the endothelium, both of which promote venous thrombosis. Depending on the relative balance between activated coagulation and thrombolysis, thrombus propagation occurs.
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- Question 1 of 10
1. Question1 points
1 which of the following are the symptoms of DVT
II Leg pain
- Question 2 of 10
2. Question1 points
2 Potential complications of DVT include the following
I heart failure
II Postthrombotic syndrome (PTS)
III Paradoxic emboliCorrectIncorrect
- Question 3 of 10
3. Question1 points
3 Treatment options for DVT include the following:
II Pharmacologic thrombolysis
III elastic compression stockings and ambulationCorrectIncorrect
- Question 4 of 10
4. Question1 points
4 Heparin products used in the treatment of DVT include the following
- Question 5 of 10
5. Question1 points
5 Factor Xa inhibitors used in the treatment of DVT include the following:
- Question 6 of 10
6. Question1 points
6 which of the following are true about the Anticoagulant therapy for DVT
I it does not remove the thrombus
II it is noninvasive
III low risk of complicationsCorrectIncorrect
- Question 7 of 10
7. Question1 points
7 which of the following drug exert their anticoagulant effect by inhibiting the activity of activated factor X.
- Question 8 of 10
8. Question1 points
8 Fondaparinux acts by
I by inhibiting the activity of activated factor X.
II selective inhibition of factor Xa,
III by inhibiting the activity of activated antithrombinCorrectIncorrect
- Question 9 of 10
9. Question1 points
9 which of the following are Factor Xa and Direct Thrombin Inhibitors
- Question 10 of 10
10. Question1 points
10 which of the following are the indications of Dabigatran
I reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
II treatment of DVT and PE in patients who have been treated with a parenteral anticoagulant for 5-10 days
III reduce the risk of DVT and PE recurrence in patients who have been previously treatedCorrectIncorrect