Below the knee DVT

[whasupmd2]

I know this is controversial, but was curious about your area standard of care? Are you guys anticoagulating these the same as other DVT? There seems to be pretty conflicting evidence.

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[ntubebate]

In my practice the care is the same. The other area docs do this as well.

ntubebate

 

[GeneralVeers]

I know this is controversial, but was curious about your area standard of care? Are you guys anticoagulating these the same as other DVT? There seems to be pretty conflicting evidence.

Most of the major texts recommend coagulation for BK DVT. Essentially the treatment is the same.

 

[Apollyon]

Most of the major texts recommend coagulation for BK DVT. Essentially the treatment is the same.

Think you forgot an "anti", bud!

 

[totalbodypain]

Think you forgot an "anti", bud!

No I've seen him work. He gives them factors, waits for the inevitable saddle embolus then calls it a day. Makes for quiker dispo you know.....

 

[Qtip96]

I know this is controversial, but was curious about your area standard of care? Are you guys anticoagulating these the same as other DVT? There seems to be pretty conflicting evidence.

the smaller DVT's (below the knee, popliteal) should be treated with therapeutic anticoagulation. reasons? it is the nature of clots to propogate. also, though this type of DVT is too small to cause the large hemodynamically threatening PEs, these small suckers are thought to be reponsible for paradoxical emboli (snake right through them PFOs which are in at least 15% of the popluation). a small clot can wreak havoc once it reaches systemic circulation.

 

[whasupmd2]

the smaller DVT's (below the knee, popliteal) should be treated with therapeutic anticoagulation. reasons? it is the nature of clots to propogate. also, though this type of DVT is too small to cause the large hemodynamically threatening PEs, these small suckers are thought to be reponsible for paradoxical emboli (snake right through them PFOs which are in at least 15% of the popluation). a small clot can wreak havoc once it reaches systemic circulation.

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[waterski232002]

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[waterski232002]

The Trauma literature only advocates anticoagulating AK clots which are deep vessels. Thus, there is no need to anticoagulate superficial clots or Below knee clots. You can just keep them on DVT prophylaxis and if the clot extends to any degree on repeat U/S (usually 1 wk) than full DVT treatment is warranted.

That being said... I know that in all the ERs I have worked in, and on the medicine wards, we anticoagulate ANY clot (regardless of AK, BK, superficial, or deep).

 

[GeneralVeers]

No I've seen him work. He gives them factors, waits for the inevitable saddle embolus then calls it a day. Makes for quiker dispo you know.....

Easier to dispo the patients when a certain attending is on shift. If everyone has a DVT/PE, then he's happy and will sign the chart.

 

[southerndoc]

The Trauma literature only advocates anticoagulating AK clots which are deep vessels. Thus, there is no need to anticoagulate superficial clots or Below knee clots. You can just keep them on DVT prophylaxis and if the clot extends to any degree on repeat U/S (usually 1 wk) than full DVT treatment is warranted.

That being said... I know that in all the ERs I have worked in, and on the medicine wards, we anticoagulate ANY clot (regardless of AK, BK, superficial, or deep).

Keypoint is that this is trauma literature and not emergency medicine literature. Trauma patients are often bedrested, ventilated, etc., whereas many of our medical patients are active and have underlying clotting disorders.

30% of all below-the-knee clots will eventually become an above-the-knee DVT. How do I know this? Because my instutition has had two M&M cases where calf thromboses were detected, not treated, and the patient subsequently returned within 5 days (both times) with PE's, one of which required thrombolytics.

 

[whasupmd2]

ouch, scary. unless you always anticoagulate.

Keypoint is that this is trauma literature and not emergency medicine literature. Trauma patients are often bedrested, ventilated, etc., whereas many of our medical patients are active and have underlying clotting disorders.

30% of all below-the-knee clots will eventually become an above-the-knee DVT. How do I know this? Because my instutition has had two M&M cases where calf thromboses were detected, not treated, and the patient subsequently returned within 5 days (both times) with PE's, one of which required thrombolytics.