【正文】 ensitivity Ddimer test indicates a low likelihood of VTE. ? Ultrasound is remended for patients with intermediate to high pretest probability of DVT in the legs. ? Patients with intermediate or high pretest probability of PE require additional diagnostic imaging studies. Deep vein thrombosis 第二十七頁(yè)，共四十六頁(yè)。 Diagnosis ? Ddimer: A fibrin degradation product, and an elevated level can result from plasmin dissolving a clot, or other conditions. Deep vein thrombosis 第十九頁(yè)，共四十六頁(yè)。 Signs and symptoms ? Common signs and symptoms of DVT include： √ Pain … √ Swelling… √ Warmth… √ Redness or discoloration… √ Distention of surface veins… Deep vein thrombosis 第十二頁(yè)，共四十六頁(yè)。 Causes ? German pathologist Rudolf Virchow postulated the interplay of three processes resulting in venous thrombosis, now known as Virchow39。 Deep vein thrombosis Xiang Yu Cheng 第一頁(yè)，共四十六頁(yè)。 Epidemiology Deep vein thrombosis According to the most recent ACCP guidelines, VTE remains the second most mon cause of protracted hospital stay and the third most mon cause of excess mortality among 7 million patients discharged from 944 acute care hospitals in the US. 第六頁(yè)，共四十六頁(yè)。 Causes ? Independent Risk Factors for DVT Deep vein thrombosis 第十一頁(yè)，共四十六頁(yè)。 Diagnosis ? DVT diagnosis requires the use of imaging devices such as ultrasound. Clinical assessments, which predict DVT likelihood, can help determine if a Ddimer test is useful. ? In those not highly likely to have DVT, a normal Ddimer result can rule out a diagnosis. Deep vein thrombosis 第十八頁(yè)，共四十六頁(yè)。 Diagnosis ?Contrast Venography: The gold standard methods to reveal whether the venous supply has been obstructed. Unilateral above knee DVT in a patient with a recent right hemisphere cerebral infarction. A 19yearold man with MayThurner syndrome with swelling of the left lower extremity. Phlebography in a patient with deep venous thrombosis. Deep vein thrombosis 第二十六頁(yè)，共四十六頁(yè)。 Treatment ? Medical Management: Anticoagulation ? New Oral Anticoagulants ? Dabigatran： direct thrombin inhibitor ? Rivaroxaban： factor Xa inhibitor Deep vein thrombosis 第三十四頁(yè)，共四十六頁(yè)。 Prevention ? Longterm plications include recurrent VTE, CTPH, and the PTS. ?The recurrence rate for idiopathic VTE approaches 30% after 10 years, the incidence of CTPH is 4% at 2 years, and the rate of PTS is 30% at 8 years. ? D dimer is an excellent test to exclude VTE. ? Duplex ultrasonography is the noninvasive test of choice for the diagnosis of DVT. Deep vein thrombosis 第四十二頁(yè)，共四十六頁(yè)。