Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

DVT · Deep Vein Thrombosis

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In one line

·A blood clot forms inside a deep vein—usually in the leg—blocking normal blood flow back to the heart.

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Normal physiology

·Deep veins carry blood from your legs back up to your heart. Your calf muscles squeeze the veins like a pump with every step. One-way valves inside the veins catch the blood and stop it from falling backward. The smooth inner lining of the vein wall keeps blood flowing without clotting. This system runs quietly all day, moving blood uphill against gravity.

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What goes wrong

·A clot forms in a deep vein when one or more parts of the normal system break down. Blood may sit still too long, the vein wall may get damaged, or the blood itself may clot too easily. Any of these—or a combination—tips the balance toward clotting instead of flowing.

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Hallmark signs

·Swelling in one calf or thigh
·Pain or tenderness in the calf or thigh
·Warmth over the swollen area
·Redness or darker color of the skin on the leg
·Swollen veins you can see or feel just under the skin
·The leg feels heavy or tight
·Shortness of breath or chest pain
·Fast heart rate or feeling dizzy

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Red flags · escalate now

·Sudden shortness of breath, chest pain, or coughing up blood — the clot may have moved to the lungs (pulmonary a traveling clot lodging in a vessel (embolism)).
·Swelling in both legs at once, or one leg that turns very pale and cold — the main vein near the belly may be blocked, or a large artery may be in trouble.
·Calling one-sided leg swelling 'a skin infection' in someone who just had surgery, was on a long trip, or cannot move much — DVT can look like an infection but needs different treatment fast.

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Workup

·D-dimer blood test
·Compression duplex ultrasound of the leg veins
·Wells score for DVT (clinical prediction rule)
·Complete blood count (CBC) with platelet count
·Creatinine and estimated glomerular filtration rate (eGFR)
·PT/INR and aPTT (if warfarin or heparin is planned)

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Treatment

·Direct oral anticoagulant (DOAC) such as apixaban or rivaroxaban, started immediately
·Compression stockings (20–30 mmHg) worn during the day and leg elevation above heart level when resting
·Low-molecular-weight heparin (LMWH, such as enoxaparin 1 mg/kg subcutaneous twice daily) bridging to warfarin in patients with cancer or severe kidney disease (eGFR < 30)
·Extended anticoagulation (at least 3 months; longer or lifelong if unprovoked or recurrent DVT)
·Early walking and movement (ambulation) as symptoms allow, NOT strict bed rest
·Catheter-directed thrombolysis (clot-busting drug delivered by a thin tube threaded into the clot) in severe cases like phlegmasia cerulea dolens (blue, painful, swollen leg with no blood flow)
·Inferior vena cava (IVC) filter placement (a small metal trap inserted into the large vein in the abdomen) only when anticoagulation is absolutely contraindicated (for example, active brain bleeding)

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NCLEX trap

·DVT usually shows up in one leg — that is the classic sign. But rarely, clots can form in both legs at the same time. Always compare the legs. One-sided swelling is your best clue, but never rule out DVT without an ultrasound.
·Homan's sign misses a lot of real DVT. It is not reliable. You need an ultrasound to see the clot. Never use a bedside test alone to decide a clot is not there.
·Aspirin helps prevent small clots from forming, but it does not break up or stop a clot that is already there. DVT needs real anticoagulation: a DOAC (like apixaban or rivaroxaban) or low-molecular-weight heparin (LMWH). These medicines stop the clot from getting bigger and lower the chance it will travel to the lungs.
·DVT swelling is usually one-sided, warm, tender, and comes with a risk factor like surgery or long travel. Cellulitis causes redness spreading up the leg, warmth, and often fever. Heart failure and kidney disease cause both legs to swell evenly and slowly. Use the Wells score to help sort DVT from other causes.
·If the Wells score is high (meaning DVT is very likely), start anticoagulation right away. Do not wait for imaging. The ultrasound confirms the clot, but you should not delay treatment. The risk of the clot traveling to the lungs is too high.
·Any patient with DVT risk factors who suddenly has trouble breathing, chest pain, or a fast heart rate may have a clot that broke off and traveled to the lungs. This is called a pulmonary embolism (a clot lodging in a lung artery) (PE), and it is life-threatening. Check for PE right away with a CT scan or D-dimer test.

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