in this video we're going to talk about deep vein thrombosis or DVT for short which is a big issue especially amongst patients postop undergoing surgery patients who are immobile chronic illness and bed bound DVT can lead to a common complication no called pulmonary embolism which is life-threatening the signs and symptoms of DVT include asymmetrical edema asymmetrical calf swelling and asymmetrical localized pain in the Cal there can be signs and symptoms of pulmonary embolism as well which is again a common complication of DVT drawing a normal leg on the left here we have a leg with DVT the leg with DVT on the left is swollen has edema with athema and is warm so deep vein thrombosis as a name implies means thrombus forming within the Deep veins so let's look at a normal vein of the legs here a normal vein of the legs have valves which assist in the hemodynamics of the veins and helps return blood back to the Heart by preventing back flow in deep vein thrombosis there is thrombus occurring Within These veins of the leg the lower legs usually and so clotting is occurring a thrombus is made up of a network of fibrin mesh platelets and red blood cells they all Clump together via coagulation Cascade and forms what's known as a thrombus there are many causes of deep vein thrombosis or thrombus formation but it can all be condensed to three things and these three things are or factors make up what we call virtuos Triad and virtuous Triad is uh includes vessel injury number one Venus stasis number two and hypercoagulability number three different diseases condition leads to one or more of these factors and this and this will predispose one to developing deep vein thrombosis and so once a thrombus has occurred the thrombus itself has a few Fates including propagation which means just growing along the vessel organization organizing within the vessel layer Rec anization forming holes within the thrombus embolism which means dislodgment of the thrombus allowing the thrombus to travel around the body via the blood a and or resolution the thrombus just gets broken down by plasmine by factors that we have in our own body but we will mainly focus on embolism because it is a common fate of thrombus in the Deep veins and can be life-threatening when a thrombus dislodges and becomes an embolis it can travel up to the heart via the inferior venina carava the heart will then pump the emis to the pulmonary circulation the emis can then Lodge into the pulmonary arteries causing a what's known sorry as a pulmonary embolism and this can subsequently cause pulmonary tissue infact if it is big and so pulmonary embolism is a big complication of deep vein osis another big complication is actually the side effects of of the medications people take who have deep vein thrombosis and these medications they can cause acute GI bleeding because the medications are anti-coagulants the risk factors for developing deep vein thrombosis essentially will fall into one or more of The Virtuous uh category The Virtuous tried category and these risks factors include pregnancy now pregnancy can cause or is a risk factor to DVT because when the uterus enlarges it can press against the inferior venina Cava causing stasis below also in pregnancy there is a rise in clotting factors other risk factors for developing deep vein thrombosis include increased age obesity malignancy having had a major surgery for the past 3 months having Medical comorbidities being hospitalized in the past 2 weeks and for patients who are hospitalized 25 to 50% of actually surgical patients can develop DVT and also many non-surgical patients other risk factors for DVT include being on certain medications such as oral contraceptives tamoxifen being on long-distant flights genetics also plays a role in increasing the risk of DVT genetics including anti-thrombin G mutation protein C and S deficiency and also antithrombin deficiency investigations for deep vein thrombosis include a full blood count liver function test electrolyte Uria creatinine INR a which are both clotting studies Imaging including Venus duplex ultrasound and imaging can also include Imaging for the chest in suspicion of pulmonary embolism there is another investigation that can be done based on the coagulation Cascade let us briefly go through the coagulation Cascade there are two Pathways in the Clum Cascade or coagulation Cascade which is the extrinsic pathway and the intrinsic pathway both the extrinsic pathway and the in intrinsic pathway will lead to a common pathway which is activation of factor 10 to factor 10 a 10 a in turn activates Factor 2 or prothrombin to factor 2 a which is known as thrombin thrombin then activates fibrinogen to fibrin fibrin forms the basis of the fibid mesh and is the last step in the formation of the thrombus so now the thrombus is formed however things can also break down the thrombus these things is plasminogen or plasmin and a plasman cleaves the fibrine creating what is now called a d dier during active thrombosis there is elevated D diers and so the measurement of a dmer can give some indication of coagulation activity that is occurring in the body however saying this tting for ddus is not very specific for deep vein thrombosis as elevated ddus also occur in a number of other conditions including pregnancy as well as post surgery and so measuring ddias is often not useful but sometimes it is useful in ruling out pulmonary embolism or deep vein thrombosis let's move on to management which is mainly anti-coagulants and essentially the anti-coagulants include heprin and there are two types of Hein that can be given low molecular weight heprin which is given IV or subcutaneous unfractured heprin warrin is given orally and needs maintenance through INR measurement essentially heprin and warrin Target some Pathways within the clotting Cascade mainly the common pathway another important management is actually prophylaxis preventing PE from occurring and this is especially important for patients who are undergoing surgery and these prophylaxis interventions include compression stockings as well as physical activity for the people that sit down a lot to keep the blood flowing