The Rational Clinical Examination
David L. Simel, Drummond Rennie
Deep Vein Thrombosis
Sonia Anand, Philip S. Wells, Dereck Hunt, Pat Brill-Edwards, Deborah Cook, Jeffrey S. Ginsberg
Introduction
Topics Discussed:
deep vein thrombosis
Excerpt:
"Deep vein thrombosis (DVT) affects approximately 2 million US
individuals per year1 and is the third most common cardiovascular
disease, behind acute coronary syndromes and stroke.2 Venous
thromboembolism represents a single disease entity, with 2 patterns
of clinical presentation: DVT and pulmonary embolism (PE). The approach
to patients who present with suspected DVT is problematic for several reasons.
If left untreated, affected patients can experience fatal PE. The
clinical diagnosis of DVT is unreliable when used in isolation without
objective testing.3,4 About three-quarters of the
patients who present with suspected DVT have nonthrombotic causes
of leg pain.5,6 Finally, although anticoagulant
therapy is highly effective in preventing the extension, embolization,
and recurrence of DVT, it is associated with an increased risk of
major bleeding (approximately 5%) and other potentially
serious consequences such as heparin-induced thrombocytopenia (approximately
1%).7 Therefore, when possible, anticoagulation
should be restricted to those with confirmed DVT. For all of these
reasons, it is important to diagnose DVT accurately. This will allow administration
of appropriate therapy for patients with documented DVT; for patients
without DVT, it will prevent unnecessary exposure of patients to
the hazards of anticoagulant therapy and prevent many from being
falsely labeled as having venous thromboembolic disease...."
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