Deep venous thrombosis (DVT) is an obstruction, partial or total, of a deep venous vessel in any district and, that in the lower extremities is by far the most common in medical practice. It should not be confused with thrombophlebitis, which is instead an inflammation of the superficial veins with or without thrombosis.
It can occur at all ages, although the incidence is much lower in the young and higher in the elderly.
The risk is increased in individuals hospitalized for trauma, major surgery, prolonged immobilization; as well as during pregnancy and puerperium and when neoplasms are found. In addition to smoking, obesity, metabolic syndrome, or other hematologic diseases.
Symptoms may be minimal or nonspecific, so it should be kept in mind that in many cases DVT may also be asymptomatic. Therefore, it is not unusual for the onset of venous thromboembolic disease to be the clinical picture of pulmonary embolism.
In general, symptoms are represented by spontaneous pain or caused by stretching of muscles (soreness on pressure along the distribution of the deep veins of the limb or Bauer's sign, soreness on dorso-plantar flexion of the foot or Homans' sign); - pain in the sole of the foot or popliteal cord; redness; cyanosis; increased skin temperature; cramping; increased limb circumference due to frank edema; late development of collateral circles; - phlegmasia alba dolens (clinical picture in which, in addition to the altered venous outflow caused by thrombosis, there is arterial vasospasm with pallor, decreased temperature of the affected limb, and arterial hyposfigmia).
The clinical diagnosis of DVT is poorly accurate and always needs instrumental verification. Failure to recognize DVT can have serious consequences, so a high level of clinical suspicion should be maintained.
The clinical diagnosis of DVT cannot be based on sufficiently sensitive and specific signs and symptoms; therefore, it is essential to arrive at a confirmation quickly through instrumental diagnostic investigations, primarily lower limb echocolordoppler, laboratory tests especially for the transmissibility of certain genetic markers (tests for thrombophilia) that, if altered, increase its incidence.
For this reason, conditions that may promote DVT should be considered subsequently by the hematologist in each individual patient for proper differential diagnosis, as they contribute to varying degrees to the risk profile, which is critical for decision making regarding subsequent diagnostic testing.
Once the diagnosis of DVT is confirmed, treatment must be addressed, with levels of involvement differing from case to case depending on whether a decision is made for home treatment or hospitalization.
Indeed, there can be a shift from management of the nonhospitalized patient even in the acute phase with oral anticoagulant therapy [DOAC], conducted in collaboration with the specialist, preferably a hematologist with expertise in coagulation and thrombosis, and the general practitioner; and cases in which the patient is hospitalized directly in the acute phase.
Another key task is the prevention of DVT, the risk of establishment of Post-Phlebitic Syndromes, and proper prophylaxis with the indication to monitor laboratory data simply by continuing and supervising the therapy already initiated by the specialist.
