Management of DVT

1) Diagnosis of DVT by:

  1. Clinical Probability (Hx, PE)
  2. U/S Doppler
  3. D- Dimer 
2) Management of DVT (Hep-Warfarin Therapy)
  1. Exclude Pul Embolism; Clinical: Hemoptysis, Tachycardia, Ix: ECG, CXR, ABG, CTPA
  2. Blood Ix (for DVT) : FBC, PT/APTT, baseline INR & APTT ratio, Thrombophilia Screening 
  3. Start Heparin
    • UFH - Loading dose 5000 U bolus, then 1000 U/HR by IVI, Monitor APTT ratio 6 HRly aim 2-3 (and change accordingly)
    • LMWH - No need monitoring (give S/C)
  4. START Warfarin D2 (aim INR: 2-3)
  5. STOP Heparin when INR > 2 x 2 consecutive days (Combination of Hep-Warfarin at least 5 days)
  6. Take DAILY INR for 1st week
  7. Maintenance Dose Warfarin ~ 2-10 mg/d
  8. Duration of Warfarin:
    • Idiopathic: 6 month
    • Recurrent: 6 month - 1 yr  
3) Find Underlying Causes 

4) Combined with Mechanical Tx of DVT
  • TED Stocking : minimize post-thrombotic event 
  • PhysioTx/ Encourage Mobility

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This is all a collection of what I have learnt during my medical student years, most of them are already a simplified version, very clinical, and comes from what my Lecturer had thought.... I love to make notes in my own way, so that I can have a better understanding on what I have seen.... I hope, this will benefit all people, especially medical students... so that you will get this right... but just bear in mind... I'm a human too... so, mistakes is still in my dictionary of life.... so, please correct me if I'm wrong... Really2x appreciate that....

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