Deep vein thrombosis and pulmonary embolism Homeostasis l

Deep vein thrombosis and pulmonary embolism.

Homeostasis l l l Vessel wall. Platelets. Circulating coagulation protein.

Thrombosis. l l Virchows triad. 1 - blood flow. 2 - surface in contact with blood. 3 - clotting components.

Blood flow. l l l Atrial fibrillation. Left ventricular dysfunction. Immobility. Vessel obstruction. Hyperviscosity. Sickle cell anemia.

Abnormalities of surfaces in contact with blood l l Vessel injury – trauma. Atherosclerosis. Heart valve disease – or replacement. Indwelling catheter.

Abnormalities of circulating coagulation proteins. l l l l Protein C and protein S deficiency. Activated protein C resistance. Antithrombin 111 deficiency. Antiphospholipid antibodies. Hyperhomocysteinemia. Malignancy. High dose estrogen therapy / pregnancy increased fibrinogen level? .

Risk factors for thrombosis. l l l Age > 40 years. Immobility. Previous DVT / PE or thromboembolic event. Surgery. Major trauma. Pregnancy / postpartum / high dose estrogen therapy. Occult and diagnosed malignancy. Inherited or acquired alteration in circulating proteins. Polycythemia. Sever heart failure. Diabetes. ?

Signs and symptoms. l l l Symptoms often absent. Symptoms non specific. Symptoms due to inflammation and obstruction of venous flow. Deep vein thrombosis : unilateral calf swelling, calf pain and tenderness, calf erythema, dilatation of superficial vein, palpable cord, Pulmonary embolism: dyspnea , chest pain, tachycardia, hypotension, cyanosis, hemoptysis.

Diagnostic testing – DVT. l l Venography. Ultrasononagraphy – Doppler. Impedance plethysmography. Fibrinogen leg scanning.

Diagnostic testing – PE. l l Pulmonary angiography. Ventilation perfusion scan. Spiral CT scan. D – dimer.

Hypercoagulable work – up. l l l Protein C deficiency. Protein S deficiency. Anti – Thrombin 111 deficiency. Activated protein C Resistance. ( factor V Lieden ). Antiphospholipid Antibodies / anticardiolipin / lupus anticoagulant.