Deep vein thrombosis (emergency department diagnosis and management)

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Target exams

Red flags

• A DVT and a PE are one disease — the venous thromboembolism — and the management of the DVT prevents the PE
• An iliofemoral DVT (the entire leg swollen, the phlegmasia) is a high-risk presentation that may need the thrombolysis, not just the anticoagulation
• A DVT in a patient with an active cancer is managed with a DOAC (apixaban or rivaroxaban) or the LMWH — not warfarin alone; the LMWH is preferred in luminal gastrointestinal or genitourinary cancers — the cancer-associated thrombosis has its own pathway
• The anticoagulation is started as soon as the diagnosis is confirmed (or the probability is high) — do not wait for the ultrasound if the Wells is high and the D-dimer is positive
• The recurrent DVT or the DVT at an unusual site (the arm, the mesenteric) prompts the thrombophilia and the malignancy screen