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Deep Vein Thrombosis

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Brittaney Petersen

on 14 September 2014

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Transcript of Deep Vein Thrombosis

Deep Vein Thrombosis
Signs and Symptoms
Originates in the Calf with persistant cramping or "charley horse"
Leg Swelling
Discomfort/discoloration



Unexplained upper arm, neck swelling
Vague sense that something is "wrong"
Pathophysiology
Blood clot formation is a normal healing process that can become pathologic in certain circumstances
Blood clots are made when protein strands, composed of fibrin, come together like a mesh.
Blood clot traps erythrocytes, phagocytes and microorganisms.
VIRCHOW TRIAD:
1. Hyper coagulability (imbalance between circulating coagulation factors)
2. Venous Stasis (decreased or altered venous blood flow)
3. Vessel Injury (Extrinsic/Intrinsic Damage to endothelial wall)

Incidences
Prevalence in the US
Mortality Rate in the US
Morbidity
50% of those with DVT will have complications
33% recurrence rate within 10 years
1:1,000 Adults anually
Rates increase >45 yrs old
1:100 those >80 yrs old
Rates slightly higher in Women than Men
Death occurs in 6% in those with DVT 10% in those with PE
Risk Factors for Thrombosis
Modifiable Risk Factors
Non-Modifiable Risk Factors
Obesity- increases the risk 2-3x's
Homocysteine - from low vitamin B levels
Estrogen levels- from Oral Contraceptives
Genetic Factors- V Leiden, prothrombin 20210A variant
Hereditary Thrombophilia
Anatomic Variants
Temporary Risk Factors
Hospitalization
Surgery/Trauma
Immobility/Inactivity
Cancer- 12.4:1,000 incidences
Prolonged Travel- (>4hrs at one time. Via car, air doubles the risk.
Assessment
Doppler Ultrasound (for upper/lower extremities)
Labs:
CBC
PT
aPTT
D-Dimer
Antithrombin Activity (AT)
Protein C Activity/Antigen
Protein S Activity (free and total antigen)
Fasting Homocysteine
Lipoproteins
Factor V Leiden gene mutation
Prothombin Gene Mutation
Factor VIII activity

Diagnostic Tests
History of DVT's
Late miscarraige
MI or stroke at age <50 yrs
Patient History
Family History
Physical Examination
Trauma
Recent surgery
Infection
Dehydration
Sharp/sudden chest pains or SOB
Estrogen use
Implanted port or central line
Repetative overhead motions (for UE clots)
See Signs and Symptoms
Treatments
Therapy Options
Observation
Pharmaceuticals- average treatment for 3-6 months
IVC filter placement- protects lungs from PE- used if anticoags are contraindicated
Stent placement- holds vessel open
Gradient compression stockings- extremity DVT's
Pharmaceuticals
Thrombolytic agent- r-tPA
Anti-platelet agents - Asparin, Plavix
Anticoagulants (DO NOT break up clots) - unfractionated heparin, Low molecular weight heparin (Lovenox) vitamin K antagonists (warfarin)
Brittaney Petersen
Westminster College
Advanced Pathophysiology
Concep Map #1
September 17, 2014
References
Research Articles
www.ncbi.nim.nih.gov- "Epidemiology and risk factors for venous thrombosis" April 2007
Pathophysiology: The biologic basis for disease in adults and children. 5th edition. McCance & Heuther
Partners in Bleeding Disorders Education: Advanced Nursing Topics in Bleeding Disorder Care. Conference Phoenix, AZ February 9-11, 2014.

"Hormonal Contraception and Thrombotic Risk: A Multidisciplinary Approach" PEDIATRICS Volume 127, Number 1, January 2011
"Updates in Thrombosis in Pediatrics: Where Are We After 20 Years?". American Society of Hematology 2012
"Approach To The Diagnosis And Therapy Of Lower Extremity Deep Vein Thrombosis". UpToDate.com 2014
As a Family Nurse Practitioner...
Prevent Immobility/inactivity: walk, jog, bike, swim.
Prevent Obesity: limit caloric intake, exercise, avoid saturated fats, maintain a healthy weight.
Prevent DVT during travel: hydrate, walk if possible, wear TED hose, avoid alcohol.
To quit smoking: use nicotine patch, gum or spray.
To prevent when planning birth control: discuss risks, consider alternatives.
To prevent DVT after surgery/trauma: use mechanical compression boots, TED hose, blood thinners IV or SQ.
To deal with known genetic predispostion: obtain an extensive family history with any abnormal blood tests or events.
Upper Extremity
Lower Extremity
Full transcript