Pulmonary emboli (PE) and deep venous thrombosis (DVT) are common causes of death and disability. It is estimated that 1% of the population will have a DVT in their lifetime. The risk of DVT is as high as 16% in patients with a family history of clotting disorders. DVT is most common in hospitalized patients, but it is not uncommon for patients to first present in the outpatient setting to their primary care physician or surgeon. Risk factors for DVT include prolonged immobilization (bedrest, long air or car trips), malignancy, hormone use, obesity, recent surgery (especially orthopedic or gynecologic procedures), and family history of clotting disorders. Even “minor” clots below the knee can propagate, and up to 30% of these clots if untreated can result in long-term limb swelling and skin changes (post-thrombotic syndrome). Early diagnosis and treatment of DVT is essential to prevent potentially deadly pulmonary embolism and disabling post-thrombotic syndrome.
Goals
The goal of Lake Washington Vascular’s DVT clinic is to provide comprehensive and seamless care for patients with DVT, from diagnosis, to treatment, to risk counseling and education. We provide the diagnostic expertise of an accredited vascular laboratory, compassionate and personalized care, immediate treatment, and long-term follow-up.
How does the clinic work?
Referrals to the DVT clinic can be made by calling or faxing our office with the patient’s information. Patients with symptoms of DVT who do not yet have a diagnosis first undergo a diagnostic duplex ultrasound. We reserve appointment slots daily (including Saturdays) on our Vascular Lab schedule for add-on “rule out DVT” scans. Results are conveyed to the referring physician whether they are positive or negative.
If our scan is positive for a DVT, one of our physicians, ARNPs, or PA-Cs will meet with the patient and initiate treatment if indicated. Most of the time patients can be treated as outpatients with low molecular weight heparin (LMWH) or fondaparinux (a Factor Xa inhibitor) and warfarin (Coumadin®). Our clinic stocks LMWH, fondaparinux, and new oral inhibitors, such as Xarelto, so we are able to give the patient their first dose while teaching them how to give themselves injections. For most patients we will provide prescriptions for compression stockings to decrease edema and discomfort. Patients receive counseling about DVT, and follow-up appointments are arranged with the anticoagulation clinic, and with one of our care providers, and with the vascular lab to continue to follow the clot as it resolves. The length of treatment is dependent on the patient’s risk factors, clinical history, the size of the clot, and the speed of resolution of the clot with treatment.
Referring physicians will receive copies of all patient laboratory and clinic visits. We will determine the duration of treatment. When it is time to stop anti-coagulation, patients will have an “exit” visit to discuss future risk of DVT, symptoms of post-thrombotic syndrome, and the risk/benefit aspects of continuing or stopping anti-coagulation.
In some circumstances, patients will require inpatient treatment for DVT. If the DVT is extensive, the patient may undergo thrombolysis of the clot in the hospital. If desired by the referring physician, we will admit and follow these patients directly from clinic. We also care for patients who have had a DVT diagnosis made by another clinic or ER.
Why should I refer my patient to Lake Washington Vascular?
The Lake Washington Vascular clinical team consists of fellowship trained vascular surgeons, ARNPs and PA-Cs. Our practice is actively involved in clinical research trials investigating novel anticoagulants for the treatment of DVT such as Factor Xa and Direct Thrombin inhibitors, as well as testing for genetic markers to guide warfarin dosing. If appropriate, we may offer your patients the opportunity to participate in these trials. We have vascular labs in Kirkland, Bellevue and Issaquah and are equipped with state-of-the-art duplex machines. Our vascular laboratory personnel have four-year degrees in vascular ultrasound. Together our expertise in diagnosing, following, and treating DVT provides exceptional care for your patient. Late afternoon and Saturday availability helps patients avoid lengthy and costly ER visits. Our care plan and broad experience with DVT provides reassurance to your patient during what can be a very anxious time.