Deep Venous Thrombosis: Diagnosis and Treatment

Diagnosis

• The first step is taking the patient’s history and performing a physical examination.
  
• Blood testing may be used.
  
• The most commonly used imaging test for DVT is an ultrasound of the extremities. It is quick, inexpensive, noninvasive, and reasonably accurate.
  
  Further tests can be used to increase accuracy. The include magnetic resonance imaging (MRI) of the extremity, plethysmography, or venography. 
  
• If pulmonary embolism is suspected, further testing is necessary.
  
  Electrocardiogram (EKG) and chest X–ray are usually the first tests ordered, but they are not as accurate as CT scan of the chest, MRI of the chest, or ventilation–perfusion scan.

Treatment

• Patients with DVT are treated with anticoagulation medications (e.g., heparin, warfarin) to reduce the tendency of the blood to clot. Uncomplicated cases are generally treated for three to six months. Patients at higher risk are treated longer, perhaps even for life.
  
  In patients who cannot use anticoagulation therapy (e.g., those with active bleeding or a history of gastrointestinal bleeding), external compression devices can be used.
  
• Surgery may be necessary in some cases, particularly for high–risk patients, those who cannot take anticoagulation medications, or those who do not respond appropriately to anticoagulation medications.