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 and PE

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In one line

·A blood clot forms in a deep vein (usually the leg), and if it breaks loose and travels to the lung, it becomes a PE (pulmonary a traveling clot lodging in a vessel (embolism))—both are part of the same disease process called VTE (venous thromboembolism).

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Normal physiology

·Normally, blood flows up from your legs through deep veins (large veins buried under muscle) back to your heart and lungs, and your body keeps blood liquid inside vessels but makes it clot quickly when a vessel is cut—this balance is called hemostasis.

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What goes wrong

·When blood flow slows down, the vein wall gets damaged, or blood gets extra sticky (Virchow's triad), platelets and clotting proteins stick together inside the vein and form a solid clot that blocks the normal return flow of blood.

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Hallmark signs

·Leg swelling (usually one leg)
·Leg pain or tenderness (often feels like a cramp in the calf)
·Warmth and redness over the swollen area
·Sudden shortness of breath
·Sharp chest pain that gets worse when you breathe in deeply or cough
·Fast heart rate (tachycardia)
·Coughing up blood (hemoptysis)
·Lightheadedness or fainting

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Red flags · escalate now

·Sudden trouble breathing or very fast breathing
·Chest pain that feels sharp or stabbing, especially with a deep breath
·Coughing up blood
·Feeling faint, dizzy, or passing out
·Fast or irregular heartbeat with sweating or confusion

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Workup

·D-dimer blood test
·Ultrasound (compression ultrasound) of the leg veins
·CT angiogram (CTA) of the chest with contrast dye
·Ventilation-blood flow (perfusion) scan (V/Q scan) if the patient can't have CT contrast (kidney disease, dye allergy)
·Wells score (clinical decision rule: leg swelling, heart rate, recent surgery, prior clot, coughing up blood (hemoptysis), cancer)
·Arterial blood gas (ABG) if PE is suspected and oxygen is low
·Troponin and BNP (brain natriuretic peptide) if massive PE is suspected
·Echocardiogram (ultrasound of the heart) if massive PE with low blood pressure

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Treatment

·Start anticoagulation immediately: DOAC (apixaban 10 mg twice daily × 7 days then 5 mg twice daily, or rivaroxaban 15 mg twice daily × 21 days then 20 mg once daily) OR low-molecular-weight heparin (enoxaparin 1 mg/kg twice daily) bridged to warfarin (INR goal 2–3)
·Use low-molecular-weight heparin (LMWH, enoxaparin) instead of DOAC if the patient is pregnant, has active cancer, or has severe kidney disease (CrCl under 30)
·Give thrombolysis (tissue plasminogen activator, tPA 100 mg IV over 2 hours, or catheter-directed tPA) if massive PE with shock (systolic BP under 90) or submassive PE with right heart strain on echo
·Place an inferior vena cava (IVC) filter if the patient has a new clot but CANNOT take anticoagulation (active bleeding, recent brain surgery, severe bleeding disorder)
·Elevate the swollen leg above heart level, start walking as soon as it's safe (early mobilization), and fit the patient for compression stockings (30–40 mmHg) once swelling is controlled
·Give oxygen (nasal cannula or mask) to keep oxygen saturation above 90%, and monitor heart rate, blood pressure, and oxygen level continuously if PE is present
·Continue anticoagulation for at least 3 months; extend indefinitely if the clot was unprovoked (no surgery, trauma, or temporary risk factor), recurrent, or the patient has active cancer or inherited clotting disorder (factor V Leiden, antiphospholipid syndrome)

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NCLEX trap

·Oxygen helps a PE patient breathe easier and protects the body while you work, but it does not break the clot or stop another clot from coming. You must start a blood thinner (anticoagulant) right away to stop the clot from growing and to prevent new clots — that is the real fix for DVT and PE.
·D-dimer is a blood test that is negative (normal) in low-risk patients and helps you rule out clots safely. But if DVT or PE is already likely (high Wells score, meaning the patient has many risk factors and symptoms), send the patient straight for ultrasound (for DVT) or CT scan (for PE) — do not wait for a lab result that might miss the clot in a high-risk person.
·Both legs swelling at the same time usually means something else is going on — heart failure (the heart is not pumping well enough to move fluid out of the legs), kidney trouble (the kidneys are not clearing extra fluid), liver trouble (not enough protein in the blood to hold fluid inside vessels), or lymph trouble (blocked drainage channels). DVT clots are almost always one-sided because one deep vein gets blocked by the clot, not two at once.
·The clot is still there even if pain and swelling go away — the symptoms get better because the body is opening backup veins and draining the extra fluid, but the clot itself takes months to dissolve. Keep the blood thinner for at least three months if something caused the clot (surgery, a long flight, being stuck in bed). Keep it forever if the clot came back a second time or if the patient has active cancer, because the risk of another clot is too high to stop.
·PE can happen at any age if there is a trigger — recent surgery, birth control pills (which thicken the blood slightly), pregnancy, cancer, a long car ride, or bed rest after an injury. PE clot scrapes the lung lining (the pleura) and causes sharp chest pain that gets worse when you breathe in (pleuritic pain), not the constant dull ache or tightness that comes with anxiety.
·An IVC filter is a tiny cage placed in the big vein (inferior vena cava) that drains the legs; it is only for patients who truly cannot take blood thinners — active bleeding (like a brain bleed or stomach ulcer bleeding right now) or severe allergy to all blood thinners. Blood thinner is the real medicine for DVT and PE; it stops clots better than a filter and does not cause the long-term problems filters can cause (the filter itself can clot or shift).

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