I. Incidence and Location
II. Pathogenesis of Deep Vein Thrombosis
III. Diagnostic Features
IV. Management
GLOSSARY
distal further away from the heart and near to the feet or fingers.
edema accumulation of fluid.
embolus, embolism a blood clot that forms in an artery, a vein, or the heart that breaks off and is carried by the circulating blood, finally lodging and blocking the artery that supplies an organ with blood; for example, pulmonary embolism is an embolus blocking the artery in the lung.
fibrin an insoluble protein that is essential to clotting of blood, formed from fibrinogen by action of thrombin.
hypercoagulability increased clotting of blood.
phlebitis inflammation of the wall of a vein.
prophylaxis prevention of disease; preventive treatment.
proximal near to a center point of the body such as the heart.
thrombus (thrombi) blood clot(s).

• I. INCIDENCE AND LOCATION A. Incidence
  Deep vein thrombosis occurs in the veins of the legs, thigh, and pelvis. It can lead to a life-threatening condition called pulmonary embolism and is a common problem world¬wide. The incidence of venous thromboembolism in the United States is approximately 600,000 cases annually. Approximately 30% of patients undergoing major surgery develop deep vein thrombosis and some cases may go undetected. High-risk procedures such as implantation of knee or hip prosthesis or other orthopedic surgery on these joints have an incidence of deep vein thrombosis of approximately 50–60% with more dangerous proximal versus below-the-knee distal deep vein thrombosis.
• II. PATHOGENESIS OF DEEP VEIN THROMBOSIS
  A. Immobilization
• III. DIAGNOSTIC FEATURES A. Symptoms and Signs
  Deep vein thrombosis occurring in the lower limbs is often difficult to diagnose from the history and physical examination. Some individuals present with pain and swelling of the calf muscle, others are asymptomatic. The obstruction to the vein causes chronic congestion of the muscle tissues which become edematous. The diagnosis may be confused with other conditions that cause aches and pains in the lower limbs such as a muscle tear, muscle cramps, a ruptured Baker’s cyst, cellulitis, and postphle-bitic syndrome. The presence of associated precipitating factors for deep venous thrombosis listed above lends strong support to its diagnosis.
• IV. MANAGEMENT A. Heparin
  All patients with proven deep vein thrombosis are treated with heparin for days and sometimes weeks followed by oral anticoagulants. The goals of therapy are to prevent pulmonary embolism, restore venous patency and valvular function in veins, and to prevent postphlebitic syndrome. For the past 40 years or more intravenous heparin has been the standard therapy used for several days before commencing oral anticoagulation with warfarin. During the past few years, however, clinical trials have shown that low molecular weight heparin (LMWH) given subcuta-neously provides the same protection as intravenous heparin. Most important, these agents can be used in the home avoiding expensive hospitalization.
• BIBLIOGRAPHY
  Bengt, I., Eriksson, Bergqvist, D., Ka¨leboet, P. et al. Ximelagatran and melagatran compared with dalteparin for prevention of venous thromboembolism after total hip or knee replacement: the METHRO II randomised trial. Lancet, 360:1441, 2002.

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