Lower limb venous thrombosis

Abstract

DVT is a common and potentially dangerous complication in all ill patients and in those individuals undergoing surgery. A high awareness of this condition and applying simple prophylactic measures when appropriate can substantially reduce the risk of such complications developing.

Making an early diagnosis of a DVT and its consequences relies on the astute clinician having a high index of suspicion in all patients. The diagnosis is most frequently made using probability scoring and a D-dimer assay in individuals who no symptoms or signs but are considered to be at high risk. In patients who have significant symptoms or signs or those in whom a DVT cannot be excluded using the above studies, the diagnosis of DVT is confirmed usually using lower limb venous compression ultrasound.

Treatment of VTE usually consists of early and rapid anticoagulation using LMWH followed by the early introduction of Warfarin. Therapeutic Warfarin doses are given for a minimum of three months and recent advances have helped in identifying individuals who will benefit from longer periods of such treatment. It is important also to recognise those patients who are at risk of developing recurrent VTE on the basis of an underlying inherited or acquired hypercoaguable condition. Some of these individuals will benefit from “lifelong” anticoagulation.

It is essential not to overlook the late complications of DVT and to institute measure to reduce the risk of these occurring. Elastic stockings should be applied to affected lower limbs for approximately 2 years.

The HIV/AIDS pandemic in South Africa has resulted in a massive rise in the number of patients being treated for VTE in local hospitals.