Clinical profile and management of deep vein thrombosis of lower limb

Abstract

Background: In India, the incidence of deep vein thrombosis (DVT) is not well highlighted and literature survey shows scanty works in this field. Most of the literature available in India is from the orthopaedic departments, overall incidence of DVT in general population is largely unknown. Materials and Methods: A 2 year prospective study to analyze the clinical profile and management of DVT of lower limb was conducted at Regional Institute of Medical Sciences, Imphal. Patients having limb pain, swelling with or without skin changes suspected of DVT were subjected to Doppler examination. Thirty-one patients with Positive test were admitted and treated with standard regimens of low molecular weight heparins (LMWH), oral warfarin, compressive stockings and supportive care. The risk factors, response to treatment, clinical course were documented using physical examination and relevant laboratory tests at regular intervals. The data was prospectively analyzed. Results: Majority of patients were less than 45 years old with no sex preponderance. No risk factors were identified in 45%, 26% had lower limb fractures, Seven percent were pregnancy related and cellulitis, electric burns, antecedent blunt Trauma, Systemic lupus erythematosis were observed in three percent of patients each. Ten percent of patients had history of immobilization due to medical illness. There was excellent response to LMWH in 93.54% of patients with two poorly responding patients requiring mechanical thrombectomy using Fogarty venous thrombectomy balloon catheter. No significant hemorrhagic complication or pulmonary embolism encountered clinically. No recurrent thrombosis or Malignancy noted during 6-16 months. Conclusion: Most of the DVTs are idiopathic and occur in less than 45 years age group. Irrespective of the etiology, LMWH and Warfarins are efficient, safety is well demonstrated, and domiciliary treatment is advisable with surveillance. Idiopathic DVTs require long term follow up to watch for recurrent thrombosis. Owing to small sample size the data cannot be extrapolated to general population to conclude the incidence. Further studies are necessary to stratify risks, and incidence in our Indian population.