Deep vein Thrombosis (DVT) - Symptoms, diagnosis and treatment. Homan sign

A deep-vein thrombosis is a blood clot, that forms within the deep veins, usually of the leg.
Rarely, it can occur in the veins of the arms, mesenteric and cerebral veins.
Deep-vein thrombosis is a common and important disease because it causes death.
clot can detach from the veins, and travel as an embolus through the right side of the heart, eventually lodged in a pulmonary artery that supplies blood to the lungs.
This is called a pulmonary embolism.

Sometimes Deep vein thrombosis is asymptomatic. Patients have no complaint and symptoms.
But almost half of cases patients have leg pain.
• Skin is Red and hot, with dilated veins.
• Swelling of the leg can be only on one sided or on both leg. It depends which vein is affected.
• positive Homan sign.
• Which means, pain or tenderness of calf.
• when examiner dorsiflexion of the patients’ ankle.
• Sometimes pain is not presented, but patient resistance against dorsiflexion. It is also can considered positive Homan sign.
The diagnosis
can be established with doppler “duplex” ultrasound.

Risk Factors:
Reduced blood flow:
Immobility for example:
bed rest.
General anesthesia and operations.
Stroke.
Long flights.
Icreased venous pressure: such as neoplasm.
Pregnancy.
Mechanical injury to the vein:
Trauma, surgery, peripherally inserted venous catheters.
Previous Deep vein thrombosis and intravenous drug abuse.
Increased blood viscosity: Polycythaemia vera, thrombocytosis, dehydration.

Constitutional Factors

Obesity, Increasing age and cancer.
Deep-vein thrombosis is rare in children, and the risk increases with age, most occurring in the over 40s.
Treatment:
The cornerstone of treatment is anticoagulation.
Low-molecular-weight heparin or fondaparinux for five days or until INR is greater than 2 for 24 hours (unfractionated heparin for patients with renal failure and increased risk of bleeding)
Vitamin K analogs for three months
In patients with cancer, consider anticoagulation for six months with low-molecular-weight heparin.
Prognosis:
Many deep-vein thrombosis will resolve with no complications.
But Death occurs in approximately 6% of deep-vein thrombosis cases within 30 days of diagnosis.

Prevention:
Leg exercises while sitting down for long periods, or having breaks from a sitting position and walking around, having an active lifestyle, and maintaining a healthy body weight are recommended.
• Wear compression stockings for long distance travelers. Who have to long sitting.


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