Deep vein thrombosis

What you need to know: Pain, swelling, and redness of the affected limb are common symptoms of deep vein thrombosis (DVT); Assess patients' clinical risk of DVT using the Wells score; Refer urgently patients with suspected DVT for D-dimer test and/or proximal leg ultrasound; Anticoagulation to prevent clot extension and embolisation is initiated in secondary care, ideally within four hours of presentation; A direct oral anticoagulant is now first line for anticoagulation in patients with DVT not associated with cancer. Deep vein thrombosis (DVT) commonly affects the lower limb, with clot formation beginning in a deep calf vein and propagating proximally. 1 It is a common venous thromboembolic (VTE) disorder with an incidence of nearly 1.6 per 1000 inhabitants a year. 2 3 4 The rate of involvement of particular sites varies: distal veins 40%, popliteal 16%, femoral 20%, common femoral 20%, and iliac veins 4%. 1 Certain medical conditions listed in box 1 increase the likelihood of clot formation in the deep veins. Upper limb DVT represents less than 10% of all DVT, and central venous catheters are the main risk factor. 7 Venocaval thromboses are rare and are associated with malignancy, compression, and vascular abnormalities. 8 This article provides an overview for non-specialists on initial approach to patients with suspected DVT.