Diagnosis, investigation, and management of deep vein thrombosis

doi:10.1136/bmj.326.7400.1180

BMJ 2003;326:1180-1184 (31 May), doi:10.1136/bmj.326.7400.1180

Clinical review

Diagnosis, investigation, and management of deep vein thrombosis

Clive Tovey, consultant in emergency medicine¹, Suzanne Wyatt, consultant in emergency medicine²

¹ Prince Charles Hospital, Merthyr Tydfil, Mid Glamorgan CF47 9DT, ² Princess of Wales Hospital, Bridgend, Mid Glamorgan CF31 1RQ

Correspondence to: C Tovey clive.tovey@nglamtr.wales.nhs.uk

Deep vein thrombosis is an important cause of morbidity andmortality worldwide, and its clinical diagnosis is unreliable.This article explains current screening and diagnostic methodsas well as treatment

The first 150 words of the full text of this article appear below.

Introduction

Venous thromboembolic disease has an estimated annual incidencein developed countries of one in 1000 people.¹ The disordercommonly manifests as deep vein thrombosis of the leg, but deep venous thrombosis may also occur in other veins (cerebral sinus,arms, retina, and mesentery).

The sequelae of deep vein thrombosis vary from complete resolutionof the clot without any ill effects through to death due topulmonary embolism. Morbidity due to deep vein thrombosis includespost-thrombotic syndrome, encompassing chronic venous hypertensioncausing limb pain, swelling, hyperpigmentation, dermatitis,ulcers, venous gangrene, and lipodermatosclerosis.

Pain or swelling of a lower limb is a common presenting complaint,and a wide differential diagnosis exists (box 1). No singleinvestigation for the diagnosis of deep vein thrombosis hasideal properties (100% sensitivity and specificity, low cost,no risk), and often several tests are performed, either sequentiallyor in combination.

Box 1: Possible causes of pain or . . . [Full text of this article]

Methods

Diagnostic methods

Treatment of deep vein thrombosis

Ongoing research

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