الفهرس 
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Abstract
Deep vein thrombosis (DVT) refers to the formation of one or more blood clots in one of the body’s deep veins, most commonly in the lower limbs (Piazza G et al 2006). Deep venous thrombosis usually affects individuals older than 40 years. The incidence of DVT increases with age in both sexes. (Cushman M et al., 2004).
Clinical risk, suspicion, and probability indicate the possibility of DVT (Caprini JA et al., 2005). A patient with symptoms and signs consistent with DVT should be assessed and the clinical (pretest) probability of acute DVT is established using a validated scoring system (modified Wells criteria). ( Wells PS et al., 2003),(Tan M et al., 2009) ,(Hirsh J et al., 2002).
If the clinical probability of DVT is low (less than two in modified Wells score), a D-dimer assay should be performed. If D-dimer assay is normal, DVT is excluded (unlikely) without the need for imaging studies. If D-dimer is raised, compression ultrasonography (CUS) is indicated. A high pretest probability (DVT likely) should be followed up by CUS.
A high modified Wells score (more than 2) should be followed by CUS. With an abnormal CUS, DVT is diagnosed. However, a normal CUS does not exclude DVT and then a D-dimer assay should be performed. In the event of a raised D-dimer, imaging should be repeated within 1 week as isolated distal DVT that have been missed initially on CUS may extend into the proximal veins and be detected on repeated scanning. (Tan M et al., 2009), ( Hirsh J et al., 2002).
Intravenous (IV) infusion of unfractionated heparin (UFH) followed by oral administration of warfarin remains the cornerstone of clinical treatment of deep vein thrombosis (DVT).
The aim of this prospective study was to define the optimal duration required for treatment of first time proximal lower limb deep vein thrombosis.
The study was carried on fifty patients with acute proximal DVT presenting to the Vascular Surgery Unit at Menofeya Main University Hospital, Sharq Elmadina Hospital and Alexandria Main University Hospitals.
Patients with first time proximal lower limb DVT were included during the duration from March 2012 till March 2014.
Patients were randomly categorized into 2 groups:
The first group: 35 patients received therapeutic heparinization with LMWH for ten days. Oral anticoagulation with warfarin was started at day seven.
The second group: 15 patients received therapeutic heparinization with UFH for ten days. Oral anticoagulation with warfarin was started at day seven.
Warfarin was continued for 3 months for all the fifty patients within therapeutic range of INR 2.5-3
In the present study, the age ranged from 53-61 years with mean age 57.3±0.1 years
Regarding the gender, we found 23 male patients (46%) and 27 female patients (54%) with male/female ratio of 1:1.2.
On studying risk factors, we found 25 patients (50%) with a definite (provoked) cause (trauma, surgery, immobilization, malignancy….etc); while the rest (25 patients, 50%) were considered as idiopathic.
All patients in our study had a clinical diagnosis of DVT with high Wells probability score that was confirmed by positive D-dimer test and proved by Duplex examination on admission.
Duplex examination revealed that all patients had axial DVT, 44% of them had popliteal vein thrombosis (highest percentage), 26 % had femoral vein thrombosis, 20 % of patients had venous thrombosis that extended to the iliac vein, and only 10 % of them had isolated calf deep vein thrombosis.
In the present study, the duration of treatment of first episode of proximal deep vein thrombosis using antithrombotic treatment (UFH & LMWH) was three months.
In our study, the overall resolution of DVT was 82 % of the patients; 22% of the patients showed complete resolution of DVT. Substantial clearance of DVT was shown in 26% of the patients. Partial resolution of DVT was found in 34% of the patients.