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Deep Vein Thrombosis
Transcript of Deep Vein Thrombosis
Signs and Symptoms
Originates in the Calf with persistant cramping or "charley horse"
Unexplained upper arm, neck swelling
Vague sense that something is "wrong"
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.
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)
Prevalence in the US
Mortality Rate in the US
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
Temporary Risk Factors
Cancer- 12.4:1,000 incidences
Prolonged Travel- (>4hrs at one time. Via car, air doubles the risk.
Doppler Ultrasound (for upper/lower extremities)
Antithrombin Activity (AT)
Protein C Activity/Antigen
Protein S Activity (free and total antigen)
Factor V Leiden gene mutation
Prothombin Gene Mutation
Factor VIII activity
History of DVT's
MI or stroke at age <50 yrs
Sharp/sudden chest pains or SOB
Implanted port or central line
Repetative overhead motions (for UE clots)
See Signs and Symptoms
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
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)
Concep Map #1
September 17, 2014
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.