Duboka venska tromboza

master's thesis

• Title (english): Deep vein thrombosis
• Author: Josip Stjepanović
• Mentor: Mislav Puljević (mentor)
• Committee member: Jure Samardžić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Mislav Puljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Duboka venska tromboza (DVT) je multifaktorska bolest koja je posljedica stvaranja ugruška
u dubokim venama udova. Najznačajnija komplikacija DVT je razvitak plućne embolije (PE),
a to se stanje zajedničkim imenom naziva venska tromboembolija (VTE). Prema lokaciji
tromba u dubokim venama razlikujemo proksimalni i distalni DVT. Proksimalni se DVT
smatra znatno opasnijim od distalnog zbog veće tendencije razvijanja PE. Incidencija DVT
raste s dobi, a preostali predisponirajući faktori su muški spol, kirurški zahvati, trudnoća,
korištenje hormonske kontracepcije, maligne bolesti, produljena imobilizacija i brojni drugi.
Tipična klinička slika uključuje crvenu, bolnu, toplu i osjetljivu nogu s edemom distalno od
lokacije tromba. DVT se može komplicirati razvojem PE, kronične venske insuficijencije
(CVI) i posttrombotskog sindroma (PTS). U dijagnosticiranju DVT se služimo Wellsovim
kriterijima za procjenu vjerojatnosti postojanja DVT temeljem koje se pacijenti mogu svrstati
u tri rizične skupine. Analizu D-dimera moraju učiniti pacijenti malog i srednjeg rizika, dok
se u pacijenata visokog rizika odmah radi pretraga kompresije color Doppler ultrazvukom
(CD US). Pri sumnji na VTE procjenjujemo rizik Wellsovom ocjenskom ljestvicom za
postojanje PE i analizom D-dimera te obizrom na navedeno, odlučujemo se za daljnji
dijagnostički put. Kompjutorizirana tomografija plućnih arterija (CTPA) je danas metoda
izbora u dijagnosticiranju PE. Antikoagulantna terapija predstavlja osnovu liječenja DVT čiji
je cilj smanjiti širenje i recidiviranje tromba. Osim antikoagulantnih lijekova, u obzir dolazi i
trombolitičko liječenje te postavljanje filtera donje šuplje vene. Liječenje PE ovisi o
hemodinamskoj stabilnosti pacijenta. Hemodinamski se stabilni pacijenti liječe
antikoagulansima, dok hemodinamski nestabilni zahtijevaju trombolitičko liječenje.

Abstract (english)

Deep vein thrombosis (DVT) is a multifactorial disease in which the clot is formed in the
deep veins of the limbs. The most significant complication of DVT is the development of
pulmonary embolism (PE). These two entities are known by the common name as venous
thromboembolism (VTE). Depending on the location of the thrombus, DVT is divided to
proximal and distal DVT. Proximal DVT is considered much more dangerous because of the
increased tendency of PE development. The incidence of DVT increases by age, while the
remaining predisposing factors are male gender, surgical procedures, pregnancy, usage of
hormonal contraception, malignancies, prolonged immobilization and many more. Typical
clinical presentation includes red, painful, warm, and tender leg with the edema distally to the
thrombus location. DVT can be complicated by the development of PE, chronic venous
insufficiency (CVI) and postthrombotic syndrome (PTS). In the diagnosis of DVT, Wells'
criteria is used for the assessment of DVT by which the patients are classified in three risk
groups. The patients of low and moderate risk should undergo D-dimer testing, while the high
risk patients should immediately undergo compression color Doppler ultrasound (CD US)
investigation. When VTE is suspected, the risk is assessed by Wells' score for PE and Ddimer
testing for determining further diagnostic algorithm. Computed tomography pulmonary
angiography (CTPA) is the method of choice for PE diagnosis. Anticoagulant therapy is the
most common mode of DVT treatment which goal is to reduce expansion of the thrombus and
it's relapse. Besides the anticoagulation therapy, thrombolysis and inferior vena cava filter
insertion should be considered. PE treatment depends on the patient's hemodynamic stability.
Hemodynamic stable patient should be treated with anticoagulants, while hemodynamic
unstable patient requires thrombolytic therapy.

• Keywords: duboka venska tromboza; plućna embolija; antikoagulantno liječenje
• Keywords (english): deep vein thrombosis; pulmonary embolism; anticoagulant therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:775550
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-02-24 13:29:00