Bloody Minded Episode 64 - Never Skip Leg Day | Lower and Upper Limb Venous Thromboembolism
Oct 14, 2025
Dive deep into the world of DVTs as the hosts unravel the mysteries of extremity clots! Discover why lower limb DVTs are a major concern, and learn about the anatomy of veins involved. Understand the dangers of phlegmasia and the critical blood tests needed before anticoagulation. Explore the management strategies for both below-knee and proximal DVTs, plus the implications of May-Thurner syndrome. Finally, get insights on upper limb DVTs, including causes and when to anticoagulate. It's a must-listen for those wanting to master clot care!
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Episode notes
The Large Angry Cow Referral
- Bashar recounted a GP referral where a patient's leg was 'crushed very badly by a very large angry cow.'
- The hosts used it to illustrate trauma as a DVT risk factor with comic effect.
White Leg To Blue Leg Progression
- The hosts described phlegmasia alba dolens (white leg) progressing to phlegmasia cerulea dolens (blue leg) with possible gangrene.
- They emphasized this is a limb‑threatening emergency needing urgent vascular/IR intervention.
Use D-Dimer With Pretest Probability
- Order D-dimer only if you can interpret it and account for age, pregnancy, malignancy and local ranges.
- Always combine D-dimer with a pre-test probability score like Wells before acting.