الفهرس 
PHYSICAL EXAMINATIONOnly 14 pages are availabe for public view
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Abstract
Deep venous thrombosis refers to the formation of one or more blood clots in one of the body’s large veins, most commonly in lower limbs. The most serious complication that can arise from DVT is pulmonary embolism which occurs in over one third of patients.
Pulmonary embolism occurs when a portion of blood clot breaks and travels in blood stream first to the heart and then to the lungs where it can partially or completely block the pulmonary artery or one of its branches.
Venous thromboembolic disease (VTE) is a multifactorial disease involving clinical risk factors as well as genetic and environmental interactions. Hereditary risk factors include factor V leiden mutation and deficiencies in proteins C, protein S, and antithrombin. Acquired risk factors include malignancy, hospitalization, immobility, surgery, venous trauma, oestrogen therapy, pregnancy, and the presence of antiphospholipid antibodies.
The diagnosis of DVT and pulmonary embolism is complicated by fact that no individual symptom or sign is unique to either disorder. Invasive testing for VTE can be safely avoided in the majority of patients using diagnostic strategies combining non invasive tests. Complete compression ultrasonography and multidetector row computed tomography appear to be safe as stand alone tests for DVT and pulmonary embolism. Highly sensitive D-dimer testing will probably become used widely as a method of excluding VTE.
As venous thrombi mainly consist of fibrin polymers, Anticoagulants are the drugs of choice in the prevention and treatment of VTE. The new anticoagulants have higher efficiency and are easier to handle because they no longer require routine monitoring however in hemodynamic unstable patients with severe pulmonary embolism thrombolytics should be considered.
Inferior vena cava filters, catheter extraction, and pulmonary embolectomy may be considered in special indications.