Deep vein thrombosis classification scheme
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ;Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Overview
Deep vein thrombosis (DVT) is classified based on the site of occlusion or clot formation. Symptom presentation and complication is largely influenced by location of the embolus.
Classification
Classification Based on Site of Thrombus Formation
- Upper extremity deep vein thrombosis (DVT): DVT of the upper limbs.
- Lower extremity DVT: DVT of the lower limbs, which is subdivided into two categories:
- Proximal vein thrombosis: Occur in the legs, and involve the popliteal, femoral or iliac veins
- Distal (calf) vein thrombosis: Confined to the deep calf veins
In studies including inpatients, 80% of DVTs are proximal and distal DVT accounts for only 20% of all DVTs, [1] [2] [3] while studies with outpatients report a proportion of distal DVT as high as 60–70%.[4] [5]
Proximal Vein Thrombosis
Proximal vein thrombosis involves the proximal veins, including the popliteal, femoral, or iliac vein. Proximal vein thrombosis is responsible for more than 90% of acute pulmonary emboli and is associated with higher mortality. [6] Clinically, proximal vein thrombosis is considered severe, as it is more commonly associated with serious, chronic diseases, such as:
More than 90% of cases of acute pulmonary embolism are due to emboli emanating from the proximal, rather than the distal vein, veins of the lower extremities. [6]
Distal vein thrombosis
Distal or calf deep vein thrombosis involves infrapopliteal veins [ie, posterior tibial veins, peroneal veins, anterior tibial veins and muscular calf veins (soleal or gemellar veins)]. It is often associated with transient risk factors,[6] such as:
- Recent surgery.
- Immobilization.
- Travel.
- Calf Vein Thrombosis
- It causes 50% of DVTs.
- High risk of embolization.
- Recurrence rate is low compared to proximal DVTs.
- ACCP Guidelines for Calf Vein Thrombosis -
- If symptoms are not severe with no risk factors, repeat ultrasound can be done weekly. (Grade 2C recommendation)
- If symptoms are severe, then treatment is required.(Grade 2C recommendation)
- If there is propagation of a thrombus, treatment is required. (Grade 1B recommendation)
- Duration treatment is low, 3 months.
Upper Extremity DVT
- It is most likely due to:
- Central venous catheters
- Effort thrombosis (Paget schoroeder syndrome)
- Cancer
- Risk of embolizing to PE is less. (10%)
- Risk of fatality is very low (1%).
- Catheter directed thrombolytic therapy.
- Anticoagulants for a period of 3 months.
References
- ↑ Anand SS, Wells PS, Hunt D, Brill-Edwards P, Cook D, Ginsberg JS (1998). "Does this patient have deep vein thrombosis?". JAMA. 279 (14): 1094–9. PMID 9546569. Unknown parameter
|month=ignored (help) - ↑ Wells PS, Hirsh J, Anderson DR; et al. (1995). "Accuracy of clinical assessment of deep-vein thrombosis". Lancet. 345 (8961): 1326–30. PMID 7752753. Unknown parameter
|month=ignored (help) - ↑ Cogo A, Lensing AW, Prandoni P, Hirsh J (1993). "Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound". Arch. Intern. Med. 153 (24): 2777–80. PMID 8257253. Unknown parameter
|month=ignored (help) - ↑ Bressollette L, Nonent M, Oger E; et al. (2001). "Diagnostic accuracy of compression ultrasonography for the detection of asymptomatic deep venous thrombosis in medical patients--the TADEUS project". Thromb. Haemost. 86 (2): 529–33. PMID 11521998. Unknown parameter
|month=ignored (help) - ↑ Oger E (2000). "Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale". Thromb. Haemost. 83 (5): 657–60. PMID 10823257. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 6.2 Galanaud JP, Sevestre-Pietri MA, Bosson JL, Laroche JP, Righini M, Brisot D, Boge G, van Kien AK, Gattolliat O, Bettarel-Binon C, Gris JC, Genty C, Quere I (2009). "Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study". Thromb. Haemost. 102 (3): 493–500. doi:10.1160/TH09-01-0053. PMID 19718469. Retrieved 2011-12-14. Unknown parameter
|month=ignored (help) - ↑ Joffe HV, Kucher N, Tapson VF, Goldhaber SZ (2004). "Upper-extremity deep vein thrombosis: a prospective registry of 592 patients". Circulation. 110 (12): 1605–11. doi:10.1161/01.CIR.0000142289.94369.D7. PMID 15353493. Retrieved 2012-10-07. Unknown parameter
|month=ignored (help)