Upper Extremity DVT (UEDVT) is far less common than Lower Extremity DVT, and posses a diagnostic challenge. We can use the Constant score in combination with D-Dimer.
Constants Score
| Feature | Score |
|---|---|
| Venous Material Present(Central venous catheter or Pacemaker thread) | 1 |
| Localised Pain | 1 |
| Unilateral Oedema | 1 |
| Other Diagnosis at least as plausible | -1 |
Investigations
- FBC
- Renal function
- Liver function
- CRP
- Clotting
- D-Dimer
Actions
- Does the patient need an Ultrasound ? (Constant’ Actions)
- Low Risk Constant‘ (≤1) & Low Age Adjusted D-Dimer [500ng/ml (age≤50) OR 10ng/ml x Age (age>50)]
- No further investigation required (Remember: it is known there are DVT’s in this group but they are unlikely to progress to become an issue, if they represent reconsider diagnosis)
- High Risk Constans’ (≥2) OR Low Risk and High Age Adjusted D-Dimer – Go to Step 2
- Low Risk Constant‘ (≤1) & Low Age Adjusted D-Dimer [500ng/ml (age≤50) OR 10ng/ml x Age (age>50)]
- Exclusions to Outpatient/Ambulatory Pathway: > MAU/AMU
- Unable to Go home and return for U/S
- CKD 5 – Creatinine Clearance <15 (eGFR <30 calculate CrCl – HERE)
- Liver Failure
- Bleed Risk (e.g. Oesophageal varices, major surgery, major trauma, intracranial bleed <4/52, grade 3 hypertensionetc.)
- NSTEMI/Unstable angina
- Outpatient Pathway:
- Order Lower leg Ultrasound: (Side, Constans’ and D-Dimer are required)
- Treatment
- First line – Apixaban – 7 day
- Second Line – Tinzaparin – 7 day OR [BNF]
- First Line in Pregnancy/Lactating
- Patient advice leaflet [PDF pg:2]
- Give patient details to AAU/SDEC – for follow up
- Inpatient Pathway:
- Commence Tinzaparin – if not contraindicated; [BNF]
- Ref to AMU/MAU
