Management of deep venous thrombosis

Management of deep venous thrombosis 

preventing first prevention of deep venous thrombosis as 1- general measures early mobilization , hydration 2- mechanical methods graduated compression stockings perioperative pneumatic compression electrical calf stimulation ,intermittent foot compression all reduce the incidence of perioperative DVT 3- pharmacological , warfarin - postoperative bleeding can be troublesme low- dose heparin (5000 in b.d) is effective in
preventing DVT and pulmonary embolism (PE)but at the risk of increased bleeding complications .low -molecular weight heparins have the advantage of once daily administration and are at least as effective as unfractionated heparin .a reduction in bleeding complications is most marked in patient undergoing hip or knee surgery .dextran 70  has not been demonstrated to reduce the incidence of DVT although it appears to reduce the incidence of PE problems with fluid overload and hypersensitivity have occurred . combination of prophylactic techniques appear additive in their reduction of DVT risk , but even with careful prophylaxis 5-20% of patients undergoing general operations sustain a DVT and up to.2% have a fatal pulmonary embolism 2- treatment because clinical diagnosis is unreliable ,objective venographic or duplux evidence of DVT should be obtained wherever possible before starting treatment .both legs should be studied a confirmed
thrombosis should be treated with weight adjusted bolus doses of low molecular weight heparin APPT monitoring is not necessary .warfarin should be started once the patient is stable and an international normal ratio (INR) of 2.5-3 obtained warfarins should be continued for 3-6 months warfarin is not always given to patient who have suffered a minor calf thrombosis since these rarely cause major pulmonary embolism .most extensive DVT start as calf thrombosis however and the long term effects on critical ares of the calf pump mechanism remains uncertain anticoagulation reduces the incidence of repeat thrombosis but dose little to prevent the post thrombotic syndrome or protect from the complications of pulmonary embolus . thrombolysis may used to resolve extensive fresh thrombus surgical thrombectomy has no place in the treatment of distal thrombosis but may prevent limb loss in the acutely ischaemic limb caused by extensive thrombosis . caval interruption by ligation plication clip or filter may be required   when there is fresh non adherent thrombus floating in the iliofemoral segment especially where there are contraindications to anticoagulation or there has been an initial minor pulmonary embolism the percutaneously inserted greenfield filter is the technique of choice

 tags:venous,deep,thrombosis,management 

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