Deep Vein Thrombosis (DVT)

Anticoagulation versus neuraxial - A patient on therapeutic anticoagulation for DVT is at risk of spinal or epidural hematoma with neuraxial techniques; the timing of holding and resuming is case-specific and coordinated with the team.

Embolization risk - An existing DVT can embolize; watch for the signs of pulmonary embolism intraoperatively (sudden hypoxemia, a drop in end-tidal CO2, hemodynamic collapse).

Prophylaxis - Perioperative VTE prophylaxis (mechanical and/or pharmacologic) matters; balance thrombosis against surgical bleeding risk.

Positioning and stasis - Avoid prolonged venous stasis, use sequential compression, and reposition carefully so as not to dislodge a fresh clot.

IVC filter patients - Some have a filter when anticoagulation is contraindicated; know the plan.

Deep vein thrombosis is thrombus formation in the deep veins, usually of the lower extremity, driven by Virchow's triad — venous stasis, endothelial injury, and hypercoagulability.

The perioperative period is prothrombotic (immobility, tissue injury, inflammation), making DVT a common complication. The two dangers are embolization to the lungs (pulmonary embolism) and, for the anesthetist, the interaction between anticoagulant therapy and neuraxial or invasive procedures.