Approach to Thrombosis

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Approach to Thrombosis

• By Dr.Sujith S.

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• History
• Physical examination
• Presence of thrombotic condidtion
• Acquired cause of hypercoagulopathy

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Initial Examination

• History
• Age
• Location of prior thrombosis if any.
• Precipitating conditons
• Drugs OCP,HRT,
• Obstetric history-Recurrent fetal loss
• Prothrombotic systemic disorders

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Cont.d

• Drugs inducing APLA
• Past history of cancer

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Physical Examination

• Palpable cord
• Calf pain U/l edema with a difference in calf
  diameters
• Warmth,tenderness,erythema ,superficial venous
  dilatation
• Pain tenderness in the thigh(painful deep vein
  syndrome.

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• Phlegmasia Cerulea Dolens-massive venous
  thrombosis of lower limbs.
• Special settings
• Recurrent unprovoked DVT in a young patient-
• Recurrent left lower extremity DVT-

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• Screening for malignancy
• Rectal Examination stool testing for occult
  blood
• Pelvic examination

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Risk factors for thrombosis

• Inherited
• Factor V leiden
• Prothrombin gene mutation
• Antithrombin deficiency
• Protein C deficiency
• Protein S deficiency
• Elevated VIII

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• Aquired
• Age
• Previous thrombosis
• Immobilization
• Major surgery
• Pregnancy puerperium
• Hospitalization
• Obesity
• Infection

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• Venous arterial
• ?Inherited
• Homocystinuria
• Dysfibrinogenemia
• ?Mixed
• Hyperhomocystenemia

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• Acquired
• Malignancy
• APLA syndrome
• Hormonal Therapy
• Polycythemia Vera
• Essential Thrombocythemia
• PNH
• TTP
• Heparin induced thrombocytopenia
• DIC

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• Factors independently associated with risk of
  thrombosis
• Agegt75 yrs
• Acute infectious disease
• cancer
• previous thrombosis

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Diagnosis Of DVT

• Compression USG
• Impedance plethysmography
• Contrast venography
• D-dimer testing

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Arterial thrombosis

• Causes
• Clinical features

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