جلطة الأوردة العميقة

Definition

Deep vein thrombosis is a clot in a deep vein, usually of the calf or thigh; its biggest danger is travelling to the lung.

Virchow’s triad

• Stasis: immobility, long travel, a cast
• Vessel wall injury: surgery, fracture, catheters
• Hypercoagulability: pregnancy, oral contraceptives, cancer, dehydration

Symptoms

• One-sided leg swelling, pain, warmth and redness
• Or no clear symptoms

Diagnosis

Venous Doppler ultrasound, and D-dimer to exclude it when probability is low.

Treatment

• Anticoagulation: low-molecular-weight heparin, a direct oral anticoagulant or warfarin
• Usually for 3 months or more depending on the cause

Prevention in hospital

• Early mobility and leg exercises
• Prophylactic heparin by risk assessment
• Intermittent pneumatic compression

Nursing care

• Do not massage the affected leg
• Watch for pulmonary embolism: sudden dyspnoea, chest pain, tachycardia
• Watch for bleeding on anticoagulants

Exam point

Sudden breathlessness with chest pain in a client with DVT or after surgery is pulmonary embolism until proven otherwise.