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Venous thrombosis

May 28, 2020

Venous thrombosis is a circulatory disorder of veins which is commonly associated with inflammation or blood clots in veins (superficial or deep).

Medications:

Superficial thrombophlebitis

  • Tab. Naprosyn SR (Naproxen 750 mg) 1 tablet per day for 5 days.
  • Ointment Thrombophob (Benzyl nicotinate topical 2 mg, Heparin topical 50 I.U.) apply thrice a day.

Deep vein thrombosis (DVT)

  • Advice bed rest and leg elevation up to 8 inches.
  • Tab. Dolo 650 (Paracetamol 650 mg) 1 tablet thrice a day for 5 days.
  • Anticoagulation (aim to keep INR between 2.0 – 3.0)
    Step 1 – tab. Xarelto (Rivaroxaban 15 mg) 1 tablet twice a day for first 5 days.
    Step 2 – from sixth day, co-administer tab. Warf (Warfarin 5 mg) 1 tablet per day.
    Step 3 – stop tab. Xarelto (Rivaroxaban 15 mg) when two consecutive INR readings are more than 2.0.
    Step 4 – measure INR every third day for the next 2 weeks and later on check INR every 2 weeks for the next 4 weeks.Continue anticoagulation for 2 – 3 months for low risk patients. Long term therapy is considered for patients with moderate risk of repeat DVT.
  • For pregnant patients – inj. Clexane (Enoxaparin) 1 mg/kg subcutaneously every 12 hours for upto 2 -3 months. Please note that warfarin is contraindicated in pregnancy.

Investigations:

  • Serum d-Dimer – if Well’s score <1 or if raised ultrasound to confirm diagnosis.
  • Venous doppler of the limb – to be done before d-dimer if Well’s score >2.

Well’s score – calculated as per following criteria:

  • Active cancer – 1 point
  • Recent immobilisation for more than 3 days – 1 point
  • Major surgery in last 3 months – 1 point
  • Tenderness along deep veins in lower limb – 1 point
  • Entire leg swelling – 1 point
  • Calf swelling 3 cm larger than the normal leg -1 point
  • Pitting edema of lower limb – 1 point
  • Dilated collateral superficial veins – 1 point
  • Previous history of DVT – 1 point
  • Alternative diagnosis at least as likely as DVT – deduct 2 points
Well’s score Probability of DVT
=/< 1 Unlikely
=/> 2 Likely
  • Well’s score =/< 1→ do d-dimer-if positive- do ultrasound – if positive treat as DVT.
  • Well’s score => 2→do first ultrasound- if negative- d-dimer -if positive treat as DVT.

Referral:

Refer to vascular surgeon for persistent thrombus to consider recanalisation.