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DVT | Essentials

Salim Rezaie, MD and Mizuho Morrison, DO
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Regardless of your clinical setting, DVT’s are a common entity that we need to be very comfortable working up and treating. And though on the surface the workup and Tx is seemingly straightforward...the truth is there are some nuances and special cases that aren’t completely intuitive...Mizuho chats with Salim Rezaie about this topic to reveal some practice changing pearls. 

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James L. -

Timely Episode. Had a 25 year old F today, recently started on high dose OCP for menorrhagia (Hgb 6!) with acute right calf pain... D-dimer 1250 and a US with a finding of a superficial vein thrombus. D/Ced OCP (shame because it was working well) with strict precautions and a repeat US in 1 week...

Mike W., MD -

Good stuff - thx for sharing James!
M

Angelina M. -

Thanks for the info on management, very helpful! As far as the diagnosis goes, I have been doing the repeat u/s in 1 wk with positive d-dimer and neg u/s for quite some time, I'm not sure if that was an MDCalc or UTD recommendation when I first started practicing; however, what I have not been doing is jumping straight to d-dimer AND u/s in moderate-risk groups (wells score of 1-2). I was double-checking with MDCalc and UTD recommendations to make sure I had not missed something / been doing it wrong for a while and it looks like they still recommend in moderate-risk groups to use a high sensitivity d-dimer only and if negative then an u/s is not needed and if positive then proceed to an u/s. Did this part of the recommendation recently change and perhaps they are not up to date yet and if so do you have a reference for the new recommendation? Thanks so much!

Mizuho M., DO -

The practice you are mentioning before is older more traditional. As Dr.Rezaie points out, DVT needs to worked up based on your clinical suspicion and pre-test probability. If you suspect DVT then an US is warranted. He sends a D-dimer at the same time in event US is negative to help direct after-care/repeat US if needed. hope that helps! Thanks for listening. ~Miz

Angelina M. -

Thanks! And just to confirm - the repeat u/s if positive d-dimer and negative u/s only if high risk is also the old way and now the recommendation is any baseline risk with a positive d-dimer and a negative u/s gets a repeat u/s in 1 week? Thanks again!

Mizuho M., DO -

You use D-Dimer for pts who are mod-high risk (ie: YOU have a high pre-test probability in)...not just any person walking in. If YOU are worried clinically about DVT, get an US and D-dimer. those with + high-sensitivity D-dimer and neg US get an repeat US.

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Urgent Care RAP November 2019 Written Summary 2 MB - PDF

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