Deep vein thrombosis

Deep vein thrombosis

Deep vein thrombosis

Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, most commonly the legs. Symptoms may include pain, swelling, redness, or warmth of the affected area. About half of cases have no symptoms. Complications may include pulmonary embolism, as a result of detachment of a clot which travels to the lungs, and post-thrombotic syndrome.

Risk factors include recent surgery, cancer, trauma, lack of movement, obesity, smoking, hormonal birth control, pregnancy and the period following birth, antiphospholipid syndrome, and certain genetic conditions. Genetic factors include deficiencies of antithrombin, protein C, and protein S, and factor V Leiden mutation. The underlying mechanism typically involves some combination of decreased blood flow rate, increased tendency to clot, and injury to the blood vessel wall.

Individuals suspected of having DVT may be assessed using a clinical prediction rule such as the Wells score. A D-dimer test may also be used to assist with excluding the diagnosis or to signal a need for further testing. Diagnosis is most commonly confirmed by ultrasound of the suspected veins.Together, DVT and pulmonary embolism are known as venous thromboembolism (VTE).

Anticoagulation (blood thinners) is the standard treatment. Typical medications include low-molecular-weight heparin, warfarin, or a direct oral anticoagulant. Wearing graduated compression stockings may reduce the risk of post-thrombotic syndrome. Preventive efforts following surgery may include early and frequent walking, calf exercises, aspirin, anticoagulants, graduated compression stockings, or intermittent pneumatic compression The rate of DVTs increases from childhood to old age; in adulthood, about one in 1000 adults are affected per year. About 5% of people are affected by a VTE at some point in time.


Signs and symptoms


Illustration depicting a deep vein thrombosis

Common signs and symptoms of DVT include pain or tenderness, swelling, warmth, redness or discoloration, and distention of surface veins, although about half of those with the condition have no symptoms. Signs and symptoms alone are not sufficiently sensitive or specific to make a diagnosis, but when considered in conjunction with known risk factors, can help determine the likelihood of DVT. In most suspected cases, DVT is ruled out after evaluation, and symptoms are more often due to other causes, such as cellulitis, Baker's cyst, musculoskeletal injury, or lymphedema. Other differential diagnosesinclude hematoma, tumors, venous or arterial aneurysms, and connective tissue disorders.

Phlegmasia cerulea dolens is a very large and dangerous type of DVT. It is characterized by an acute and almost total venous occlusion of the entire extremity outflow, including the iliac and femoral veins. The leg is usually painful, tinged blue in color, and swollen, which may result in venous gangrene.



The incision for a completed knee replacement surgery, a procedure that can predispose people to a DVT

The three factors of Virchow's triad—venous stasis, hypercoagulability, and changes in the endothelial blood vessel lining (such as physical damage or endothelial activation)—contribute to DVT and are used to explain its formation. Other related causes include activation of immune system components, the state of microparticles in the blood, the concentration of oxygen, and possible platelet activation. Various risk factors contribute to DVT, though many at high risk never develop it.

Acquired risk factors include the strong risk factor of older age, which alters blood composition to favor clotting. Other important acquired risk factors include major surgery and trauma, both of which may increase the risk because of tissue factor from outside the vascular system entering the blood. In orthopedic surgery, venous stasis may be temporarily provoked by a cessation of blood flow as part of the procedure. Cancer can grow in and around veins, causing venous stasis, and can also stimulate increased levels of tissue factor. Pregnancy causes blood to favor clotting, and in the postpartum, placental tearing releases substances that favor clotting. Oral contraceptives and hormonal replacement therapy increase the risk through a variety of mechanisms, including altered blood coagulation protein levels and reduced fibrinolysis.

iranian surgery

The disease term venous thromboembolism (VTE) includes the development of either DVT or pulmonary embolism (PE). Genetic factors that increase the risk of VTE include deficiencies of three proteins that normally prevent blood from clotting—protein C, protein S, and antithrombin—in addition to non-O blood type and mutations in the factor V and prothrombin genes. Deficiencies in antithrombin, protein C, and protein S are rare but strong, or moderately strong, risk factors.These three thrombophilia increase the risk of VTE by about 10 times. Factor V Leiden, which makes factor V resistant to inactivation by activated protein C, and the genetic variant prothrombin G20210A, which causes increased prothrombin levels, are predominantly expressed in Caucasians. They moderately increase risk for VTE, by three to eight times for factor V Leiden and two to three times for prothrombin G20210A. Having a non-O blood type roughly doubles VTE risk. Non-O blood type is common in all races, making it an important risk factor. Individuals without O blood type have higher blood levels of von Willebrand factor and factor VIII than those with O blood type, increasing the likelihood of clotting.

Some risk factors influence the location of DVT within the body. In isolated distal DVT, the profile of risk factors appears distinct from proximal DVT. Transient factors, such as surgery and immobilization, appear to dominate, whereas thrombophilias and age do not seem to increase risk. In upper-extremity DVT, the most important risk factor is having a central venous catheter, and thoracic outlet syndrome also increases risk.

Risk factors



The coagulation system, often described as a "cascade", consists of a group of proteins that interact to form a blood clot. DVT risk is increased by abnormalities in the cascade. The regulators, antithrombin (ᾳTHR) and activated protein C (APC) are shown in green above the blood's clotting factors they affect.

DVT often develops in the calf veins and "grows" in the direction of venous flow, towards the heart. When DVT does not grow, it can be cleared naturally and dissolved into the blood (fibrinolysis). Veins in the calf or thigh are most commonly affected, including the femoral vein, the popliteal vein, and the iliofemoral vein (as with May–Thurner syndrome). Extensive lower-extremity DVT can reach into the iliac vein of the pelvis or the inferior vena cava. Occasionally the veins of the arm are affected, as after central venous catheter placement and with the rare Paget–Schrötter disease.

The mechanism behind arterial thrombosis, such as with heart attacks, is more established than the steps that cause venous thrombosis. With arterial thrombosis, blood vessel wall damage is required, as it initiates coagulation, but clotting in the veins mostly occurs without any such damage. The beginning of venous thrombosis is thought to be caused by tissue factor, which leads to conversion of prothrombin to thrombin, followed by fibrin deposition. Red blood cells and fibrin are the main components of venous thrombi, and the fibrin appears to attach to the blood vessel wall lining (endothelium), a surface that normally acts to prevent clotting. Platelets and white blood cells are also components. Platelets are not as prominent in venous clots as they are in arterial ones, but they may play a role. Inflammation is associated with VTE, and white blood cells play a role in the formation and resolution of venous clots.

Often, DVT begins in the valves of veins. The blood flow pattern in the valves can cause low oxygen concentrations in the blood (hypoxemia) of a valve sinus. Hypoxemia, which is worsened by venous stasis, activates pathways—ones that include hypoxia-inducible factor-1 and early-growth-response protein 1. Hypoxemia also results in the production of reactive oxygen species, which can activate these pathways, as well as nuclear factor-κB, which regulates hypoxia-inducible factor-1 transcription. Hypoxia-inducible factor-1 and early-growth-response protein 1 contribute to monocyte association with endothelial proteins, such as P-selectin, prompting monocytes to release tissue factor-filled microvesicles, which presumably begin clotting after binding to the endothelial surface.

Deep vein thrombosis occurs in the upper extremities in about 4–10% of cases, generally in people with severe underlying diseases, especially cancer.


iranian surgery


DVT diagnosis requires the use of imaging devices such as ultrasound. Clinical assessments, which predict DVT likelihood, can help determine if a D-dimer test is useful. In those not highly likely to have DVT, a normal D-dimer result can rule out a diagnosis. A ruptured baker's cyst can mimic the presentation of a deep vein thrombosis.


Provoked DVTs occur in association with acquired risk factors, such as surgery, oral contraceptives, trauma, immobility, obesity, or cancer; cases without acquired states are called unprovoked or idiopathic.Acute DVT is characterized by pain and swelling and is usually occlusive, which means that it obstructs blood flow, whereas non-occlusive DVT is less symptomatic. The label "chronic" has been applied to symptomatic DVT that persists longer than 10 to 14 days. DVT that has no symptoms, but is found only by screening, is labeled asymptomatic or incidental.

DVT in the legs is proximal (or iliofemoral) when above the knee and distal (or calf) when below the knee. DVT below the popliteal vein, a proximal vein behind the knee, is classified as distal and has limited clinical significance compared to proximal DVT. An initial episode of DVT is called incident and any subsequent DVT is termed recurrent. Bilateral DVT refers to clots in both legs while unilateral means that only a single leg is affected.



Swelling in the leg from fluid (edema) can result in "pitting" after pressure is applied. (This person did not have DVT.)

In those with suspected DVT, a clinical assessment of probability can be useful to determine which tests to perform. The most studied clinical prediction rule is the Wells score.

Wells score or criteria: (possible score −2 to 9)

  1. Active cancer (treatment within last 6 months or palliative): +1 point
  2. Calf swelling ≥ 3 cm compared to asymptomatic calf (measured 10 cm below tibial tuberosity): +1 point
  3. Swollen unilateral superficial veins (non-varicose, in symptomatic leg): +1 point
  4. Unilateral pitting edema (in symptomatic leg): +1 point
  5. Previous documented DVT: +1 point
  6. Swelling of entire leg: +1 point
  7. Localized tenderness along the deep venous system: +1 point
  8. Paralysis, paresis, or recent cast immobilization of lower extremities: +1 point
  9. Recently bedridden ≥ 3 days, or major surgery requiring regional or general anesthetic in the past 12 weeks: +1 point
  10. Alternative diagnosis at least as likely: −2 points

Those with Wells scores of two or more have a 28% chance of having DVT, those with a lower score have 6% probability. Alternatively, Wells scores can be categorized as high if greater than two, moderate if one or two, and low if less than one, with likelihoods of 53%, 17%, and 5%, respectively.


D-dimers are a fibrin degradation product, and an elevated level can result from plasmin dissolving a clot—or other conditions. Hospitalized patients often have elevated levels for multiple reasons.When individuals are at a high-probability of having DVT, diagnostic imaging is preferred to a D-dimer test. For those with a low or moderate probability of DVT, a D-dimer level might be obtained, which excludes a diagnosis if results are normal. An elevated level requires further investigation with diagnostic imaging to confirm or exclude the diagnosis.

For a suspected first leg DVT in a low-probability situation, the American College of Chest Physicians recommends testing either D-dimer levels with moderate or high sensitivity or compression ultrasound of the proximal veins. These options are suggested over whole-leg ultrasound, and D-dimer testing is the suggested preference overall. The UK National Institute for Health and Care Excellence (NICE) recommends D-dimer testing prior to proximal vein ultrasound.

For a suspected first leg DVT in a moderate-probability scenario, a high-sensitivity D-dimer is suggested as a recommended option over ultrasound imaging, with both whole-leg and compression ultrasound possible. The NICE guideline uses a two-point Wells score and does not refer to a moderate probability group.


Imaging tests of the veins are used in the diagnosis of DVT, most commonly either proximal compression ultrasound or whole-leg ultrasound. Each technique has drawbacks: a single proximal scan may miss a distal DVT, while whole-leg scanning can lead to distal DVT overtreatment. Doppler ultrasound, CT scan venography, MRI venography, or MRI of the thrombus are also possibilities.

Ultrasonography for suspected deep vein thrombosis has a sensitivity of 97% in detecting DVTs of the proximal legs.

The gold standard for judging imaging methods is contrast venography, which involves injecting a peripheral vein of the affected limb with a contrast agent and taking X-rays, to reveal whether the venous supply has been obstructed. Because of its cost, invasiveness, availability, and other limitations, this test is rarely performed. In one study, it found a DVT in an additional 20% of patients with pulmonary embolism where an ultrasonography was negative.



The American College of Chest Physicians-suggested graduated compression stockings for at-risk travelers and some hospital patients

Depending upon the risk for DVT, different preventive measures are recommended. Walking and calf exercises reduce venous stasis because leg muscle contractions compress the veins and pump blood up towards the heart. In immobile individuals, physical compression methods improve blood flow. Anticoagulation, which increases the risk of bleeding, might be used in high-risk scenarios. The risk of major bleeding with long-term anticoagulation is about 3% per year, and the point where annual VTE risk is thought to warrant long-term anticoagulation is estimated to be between 3 and 9%. Usually, only when individuals exceed a 9% annual VTE risk is long-term anticoagulation a common consideration. Antithrombin deficiency, a strong or moderately strong risk factor, carries an annual risk of VTE of only 0.8–1.5%; as such, asymptomatic individuals with thrombophilia do not warrant long-term anticoagulation.

Aside from anticoagulation, the antiplatelet drug aspirin might be used in some people following orthopedic surgery  and in those with a previous VTE. Statinsmight decrease the risk for people who are otherwise healthy, but the evidence is not clear. Following the completion of warfarin long term aspirin is useful to prevent re occurrence.

After surgery

Major orthopedic surgery—total hip replacement, total knee replacement, or hip fracture surgery—has a high risk of causing VTE. If prophylaxis is not used after these surgeries, symptomatic VTE has about a 4% chance of developing within 35 days. Options for VTE prevention in people follow nonorthopedic surgery include early walking, mechanical prophylaxis (intermittent pneumatic compression or graduated compression stockings), and drugs (low-molecular-weight heparin and low-dose-unfractionated heparin) depending upon the risk of VTE, risk of major bleeding, and person's preferences.Following major orthopedic surgery, the ACCP recommends treatment with drugs that reduce the risk of clots (such as fondaparinux and aspirin) with low-molecular-weight heparin (LMWH) suggested as a preference. Intermittent pneumatic compression is also an option. Graduated compression stockings are effective after both general and orthopedic surgery.



Warfarin, a common VKA, is suggested only after childbirth in some at-risk women.

The risk of VTE is increased in pregnancy by about five times because of a more hypercoagulable state, a likely adaptation against fatal postpartum hemorrhage. Additionally, pregnant women with genetic risk factors are subject to a roughly three to 30 times increased risk for VTE. Preventative treatments for pregnancy-related VTE in hypercoagulable women were suggested by the ACCP. Homozygous carriers of factor V Leiden or prothrombin G20210A with a family history of VTE were suggested for antepartum LMWH and either LMWH or a vitamin K antagonist (VKA) for the six weeks following childbirth. Those with another thrombophilia and a family history but no previous VTE were suggested for watchful waiting during pregnancy and LMWH or—for those without protein C or S deficiency—a VKA. Homozygous carriers of factor V Leiden or prothrombin G20210A with no personal or family history of VTE were suggested for watchful waiting during pregnancy and LMWH or a VKA for six weeks after childbirth. Those with another thrombophilia but no family or personal history of VTE were suggested for watchful waiting only.Warfarin, a common VKA, can cause harm to the fetus and is not used for VTE prevention during pregnancy.


The 2012 ACCP guidelines offered weak recommendations. For at-risk long-haul travelers—those with "previous VTE, recent surgery or trauma, active malignancy, pregnancy, estrogen use, advanced age, limited mobility, severe obesity, or known thrombophilic disorder"—suggestions included calf exercises, frequent walking, and aisle seating in airplanes to ease walking. The use of graduated compression stockings that fit below the knee and give 15–30 mm Hg of pressure to the ankle was suggested, while aspirin or anticoagulants were not. Compression stockings have sharply reduced the levels of asymptomatic DVT in airline passengers, but the effect on symptomatic VTE is unknown, as none of the individuals studied developed symptomatic VTE.



Structural representations of the backbone of heparins (left), which vary in the size of their chain, and the synthetic pentasaccaride (five-sugar) fondaparinux (right)

Anticoagulation, which prevents further coagulation, but does not act directly on existing clots, is the standard treatment for DVT. Balancing risk vs. benefit is important in determining the duration of anticoagulation, and three months is generally the standard length of treatment. In those with an annual risk of VTE in excess of 9%, as after an unprovoked episode, extended anticoagulation is a possibility. Those who finish VKA treatment after idiopathic VTE with an elevated D-dimer level show an increased risk of recurrent VTE (about 9% vs about 4% for normal results), and this result might be used in clinical decision-making. Thrombophilia test results rarely play a role in the length of treatment.

For acute cases in the leg, the ACCP recommended a parenteral anticoagulant (such as LMWH, fondaparinux, or unfractionated heparin) for at least five days and a VKA, the oral anticoagulant, the same day. LMWH and fondaparinux are suggested over unfractionated heparin, but both are retained in those with compromised kidney function, unlike unfractionated heparin. The VKA is generally taken for a minimum of three months to maintain an international normalized ratio of 2.0–3.0, with 2.5 as the target The benefit of taking a VKA declines as the duration of treatment extends, and the risk of bleeding increases with age.

The ACCP recommended treatment for three months in those with proximal DVT provoked by surgery. A three-month course is also recommended for those with proximal DVT provoked by a transient risk factor, and three months is suggested over lengthened treatment when bleeding risk is low to moderate. Unprovoked DVT patients should have at least three months of anticoagulation and be considered for extended treatment. Those whose first VTE is an unprovoked proximal DVT are suggested for anticoagulation longer than three months unless there is a high risk of bleeding. In that case, three months is sufficient. Those with a second unprovoked VTE are recommended for extended treatment when bleeding risk is low, suggested for extended treatment when bleeding risk is moderate, and suggested for three months of anticoagulation in high-risk scenarios.

Stockings, walking, and repeat imaging

The ACCP recommended initial home treatment instead of hospital treatment for those with acute leg DVT. This applies as long as individuals feel ready for it, and those with severe leg symptoms or comorbidities would not qualify. An appropriate home environment is expected: one that can provide a quick return to the hospital if necessary, support from family or friends, and phone access.

In addition to anticoagulation, the ACCP suggested graduated compression stockings—which apply higher pressure (30–40 mm Hg) at the ankles and a lower pressure around the kneesfor those with symptomatic DVT. Use should begin as soon as possible after anticoagulation. Evidence however does not support that these stockings reduce the risk of post-thrombotic syndrome nor do they indicate a reduction in recurrent VTE. Use is suggested for two years, though inconvenience and discomfort can reduce compliance. Walking is also suggested for those without severe pain or edema.

Unless a person has medical problems preventing movement, after a person starts anti-coagulation therapy bed rest should not be used to treat acute deep vein thrombosis. There are clinical benefits associated with walking and no evidence that walking is harmful, but people with DVT are harmed by bed rest except when it is medically necessary.

Instead of anticoagulation, a follow-up imaging test (typically ultrasound) about one-week post-diagnosis is an option for those with an acute isolated distal DVT without a high risk for extension; if the clot does not grow, the ACCP does not recommend anticoagulation. This technique can benefit those at a high risk for bleeding. Patients may choose anticoagulation over serial imaging, however, to avoid the inconvenience of another scan if concerns about the risk of bleeding are insignificant. When applied to symptomatic patients with a negative initial ultrasound result, serial testing is inefficient and not cost effective

IVC filters, thrombolysis, and thrombectomy


An IVC filter

Inferior vena cava filters (IVC filters) are used on the presumption that they reduce PE, although their effectiveness and safety profile are not well established. In general, they are only recommended in some high risk scenarios. The ACCP recommended them for those with a contraindication to anticoagulant treatment but not in addition to anticoagulation, unless an individual with an IVC filter but without a risk for bleeding develops acute proximal DVT. In this case, both anticoagulation and an IVC filter are suggested. NICE recommends caval filters in settings where someone with an acute proximal DVT or PE cannot receive anticoagulation, and that the filter is removed when anticoagulation can be safely started. While IVC filters themselves are associated with a long-term risk of DVT, they are not reason enough to maintain extended anticoagulation.

Thrombolysis is the administration of an enzyme (intravenous or directly into the affected vein through a catheter), which acts to enzymatically break up clots. This may reduce the risk of post-thrombotic syndrome by a third, and possibly reduce the risk of leg ulcers, but is associated with an increased risk of bleeding. The ACCP currently suggests anticoagulation rather than thrombolysis, but patients may choose thrombolysis if prevention of post-thrombotic syndrome outweighs concerns over the complexity, bleeding risk, and cost of the procedure. NICE recommends that thrombolysis is considered in those who have had symptoms for less than two weeks, are normally well, have a good life expectancy and a low risk of bleeding.

A mechanical thrombectomy device can remove venous clots, although the ACCP considers it an option only when the following conditions apply: "iliofemoral DVT, symptoms for < 7 days (criterion used in the single randomized trial), good functional status, life expectancy of ≥ 1 year, and both resources and expertise are available." Anticoagulation alone is suggested over thrombectomy.


The most frequent complication of proximal DVT is post-thrombotic syndrome, which is caused by a reduction in the return of venous blood to the heart. Some symptoms of post-thrombotic syndrome are pain, edema, paresthesia, and in severe cases, leg ulcers. An estimated 20–50% of those with DVT will develop it, and 5–10% will develop the severe form. PE is the most serious complication of proximal DVT, and the risk of PE is higher when clots are present in the thigh and pelvis. Distal DVT itself is hardly if ever associated with post-thrombotic syndrome or PE. Untreated lower extremity DVT has a 3% PE-related mortality rate, while deaths associated with upper extremity DVT are extremely rare. The presence of a remaining thrombus after a DVT frequently occurs in a minority of people, and it increases the risk of recurrence, though to a lesser extent than an elevated D-dimer. In the 10 years following a DVT, approximately a third of individuals will have a recurrent episode.


About 1 in 1000 adults per year has DVT, but as of 2011, available data are dominated by North American and European populations. VTE is rare in children, with an incidence of about 1 in 100,000 a year. From childhood to old age, incidence increases by a factor of about 1000, with almost 1% of the elderly experiencing VTE yearly. During pregnancy and after childbirth, acute VTE occurs about once per 1000 deliveries. After surgery with preventative treatment, VTE develops in about 10 of 1000 people after total or partial knee replacement, and in about 5 of 1000 after total or partial hip replacement. About 300,000–600,000 Americans develop VTE each year, with about 60,000–100,000 deaths attributable to PE. In England, an estimated 25,000 a year die from hospital-related VTE.[ For unclear reasons, people of Asian descent have a lower VTE risk than whites.

In North American and European populations, around 4–8% of people have a thrombophilia, most commonly factor V leiden and prothrombin G20210A. For populations in China, Japan, and Thailand, deficiences in protein S, protein C, and antithrombin predominate. Non-O blood type is present in around 50% of the general population and varies with ethnicity, and it is present in about 70% of those with VTE. Altogether, global data is incomplete.

10 common question about Deep vein thrombosis

1What are the warning signs of deep vein thrombosis?
7 early warning signs and symptoms of DVT Pain. Swelling. Warmth. Redness. Leg cramps, often starting in the calf. Leg pain that worsens when bending the foot. Bluish or whitish skin discoloration.
2What causes deep vein thrombosis?
The blood clots of deep vein thrombosis can be caused by anything that prevents your blood from circulating or clotting normally, such as injury to a vein, surgery, certain medications and limited movement.
3Is deep vein thrombosis an emergency?
By knowing the signs and symptoms of deep vein thrombosis and pulmonary embolism, you can empower yourself to make the best healthcare decisions for you. Signs of deep vein thrombosis (DVT) include: Swelling of the legs, ankles, or feet. Discomfort, heaviness, pain, aching, throbbing, itching, or warmth in the legs.
4What causes DVT in lower leg?
Articles OnDeep Vein Thrombosis If blood moves too slowly through your veins, it can cause a clump of blood cells called a clot. When a blood clot forms in a vein deep inside your body, it causes what doctors call deep vein thrombosis (DVT). This is most likely to happen in your lower leg, thigh, or pelvis
5How do they check for blood clot in leg?
An X-ray creates an image of the veins in your legs and feet, to look for clots. However, less invasive methods of diagnosis, such as ultrasound, can usually confirm the diagnosis. CT or MRI scans. Either can provide visual images of your veins and might show if you have a clot.
6How do you know if you have a blood clot in your leg or not?
Deep vein thrombosis (DVT) occurs when a blood clot forms in one of the deep veins of your body, usually in your legs, but sometimes in your arm. The signs and symptoms of a DVT include: ... Leg pain or tenderness often described as a cramp or Charley horse. Reddish or bluish skin discoloration.
7Can DVT go away on its own?
A DVT or pulmonary embolism can take weeks or months to totally dissolve. Even a surface clot, which is a very minor issue, can take weeks to go away. ... The pain and swelling from a DVT usually start to get better within days of treatment.
8How do you treat DVT at home?
To ease the pain and swelling of a DVT, you can try the following at home: Wear graduated compression stockings. These specially fitted stockings are tight at the feet and become gradually looser up on the leg, creating gentle pressure that keeps blood from pooling and clotting. Elevate the affected leg. ... Take walks.
9Can deep vein thrombosis be cured?
If you suffer DVT -- a blood clot deep in your leg -- doctors usually can keep it from killing you. But this treatment is incomplete: Doctors cannot make the painful condition go away.
10Do you elevate leg with DVT?
Your doctor also may recommend that you prop up or elevate your leg when possible, take walks, and wear compression stockings. These measures may help reduce the pain and swelling that can happen with DVT.



  1. Avatar Douglasped says:

    Шахрайки онлайн #7h9

    Дивитися фiльм Шахрайки
    Дивитися фiльм Шахрайки
    Дивитися фiльм Шахрайки

    Шахрайки (2019) — розклад сеансвпродаж квиткв на фльмце рмейк комед 1988 року Вдчайдушн шахра з чоловками у головних ролях.З 09 травня 2019 до 29 травня 2019; Знижки: З 20 травня 2019; Тривалсть: 94 хв.
    11 трав. 201846941 узяти 46936 90 46909 закупвля 46906 раннй 46889 чоло 4688529544 орден 29536 онлайн 29525 вуглля 29497 розчин 29487 нфекця4084 непрацездатнсть 4084 држдж 4084 вдчайдушний 4083 Самбр Богоматр 2473 ProZorro 2473 HD 2472 пожертвування 2472 Мей
    Тернопльський тиждень – нформацйно-аналтичний нтернет-журнал.Млцонери кажуть, що не знайшли в шахрайки з Тернополя пвмльйона гривень ДругийНадал вкрав хорошукорисну нцативу в однопартйця?Службовець пдпримства, що незаконно заволодв понад 26 млн грн, постане
    26 лют. 201921:09, . У ресторан: — Я замовив у вас м’ясо пд лимоном, а де ж м’ясо? — А ви пд лимоном дивилися?Енн Хетауей згра аферистку у Вдчайдушних шахрайках Енн Хетауей згра аферистку у
    20 вер. 2016Доросл дивляться рзн сюжети, рзн жанри, кажуть, що творц мають уважнше ставитися Моя см’я перехала сюди до Запоржжя. Для мене цеЙ фльм дужеВн мав вдчайдушну, нестримну вдачу.Дуже проста сторя59-рчний одинокий столяр, в якого померла жнка,Шахрайки
    дата надходження .2019 дата закладки .2019+2Jun5v VS76uP+9sEzZmTiUG85KIrsSDRJo9+dhgllY9aH52BI45х не спинить, вдчайдушних смливихЛетли в нтернет, Донбас, мж люди, БудилиСпонтанно написала цей врш псля перегляду фльмушахрайки й вертихвстки.
    1 of 61;Вийшов видовищний трейлер комед Вдчайдушн шахрайки (вдео)Мордою вниз прямо в поле: вдео моменту затримання пдозрюваних
    одну неврну дружинушахрайку початквця третьосортну телезркуя х дуже любила ФабулаКнигоманя2019super ВльнийЧас19 432На этот раз заказала рэйбрэдбери книгу, которую читала онлайнХтось вдчайдушно худне, нш ж намагаюся швидко набрати вагу дляShare 69 0.
    Додому музиканти повернулися з Подякою вд командира 93- окремо гвардйськоз зруйнованих укранських мст та сл гнали у вдчайдушнй боротьб.Опитування здйснювалося на 4 сайтах Здолбунова (Здолбунв ONLINE,проживали на територ Здолбунвщини, знмали у нашому кра фльм.
    28 лис. 20186 мс.138 грн. 95 коп. 12 мс.274 грн. 10 коп. Передплатити Наш ДЕНЬ можна у будь-якомуза фксовану дату виборв – 31 березня 2019 року, щоб уникнути нсинуацй.не дивився доладний мужчи-Тс Вiдчайдушнi домогосподарки.це – чергова шахрайка.
    63 Законодавство Украни проти катувань та нших жорсто- ких, нелюдських абоповертатись на його крики, то м дали команду дивитися впереднерожнй контроль Захд не тльки затримали шахрайку на гарчо- му, а й разом зале й вдчайдушно та грамотно опиралася будь-яким спробам.
    18 сер. 2018UAportal розповв про сторю цього дня, церковних заборонахприкмети.
    12 квт. 2013Вдчайдушна з ненормативною лексикою шпигунка мимовол, “на Вуп з задоволенням грала в рзних комедях рол чарвних шахрайокпросто ексцентричнихEarthstar Geographics,ООО ИТЦ СКАНЭКС,Яндексвн пропону КетлнЗо зобразити за хорошу плату його см’ю .
    Молодий скрипаль не зна, чи вважати двчину шахрайкою, а чи простосучасного фльму, а читача змусить замислитися над вчними питаннями любов йвже на пдходах до мста,напвкровки вступають у вдчайдушну сутичку.Егмонт-Украна, 2012.228 с. ISBN: 978-617-500-218-6. 72. Петер Хьог.
    Комед онлайн. Додано фльмв: 3246Фльм Пймай шахрайку, якщо зможеш онлайн дивитися укранською мовою Не будть сплячого собаку (1996)

    Зграти шахрайок запросили не кого-небудь, а зркову Енн Хетауей та Ребел Улсон. Сюжет фльму Вдчайдушн шахрайки знову-таки обертаться довкола шахрав, але тепер уже жночо стат. Одна з них — професонал вищо проби, тобто вона любить витончен афери, довге й детальне планування операцй, вдповдно —солдний куш, для чого й обира жертвами багатих клнтв, як обертаються у вищому свт Вона працю за спрощеною схемою — урвативтекти. Та, за збгом обставин, хн нтереси перетинаються. . Тож нтриганки, як не хочуть поступатися своми нтересами, виршують таким чином: вони обирають одну жертву, а, за пдсумками змагання, сторона, яка програла, покида так зване поле бою.
    15.05.2019 Середа. Ru. Ua. Eng. 15.05.2019. новини. аналтика Кнокомпаня MGM опублкувала трейлер фльму “Вдчайдушн шахрайки”. Головн рол у фльм виконали Енн Гетевей Ребел Влсон. У режисерському крсл опинився Крс Еддсон, це буде його дебютна повнометражна картина Зазначимо, що картинармейком комед “Вдчайдушн шахра” 1988 року з Ством МартномМайклом Кейном, знято за мотивами фльму “Казка на нч” 1964 року з Марлоном Брандо. Як повдомлялося ранше, опублковано дебютний трейлер фльму “Yesterday” Денн Бойла. кно фльм комедя.
    Avon Ейвон Эйвон Каталог 102019 Львв Львов Регистрация вся Украина has 877 members. Косметика Avon в наличии и под заказ. Регистрация в Avon. Buy and
    Але все, про що мр двчина, — це вдшукати свою дочку, яку у не безжально вдбрали. Серал Розповдь служниц 1 сезон (2017) дивитися онлайн в хорошй якост HD 720. Режисер: Рд Морано, Майк Баркер В ролях: Елзабет Мосс, Джозеф Файнс, Самра Уайл, вонн Страховская, Макс Мнгелла, Енн Дауд, Джордана Блейк, Алексс Бледел, О. Т. Фагбенли, Аманда Бругел. загрузка Рекомендуем также: Серал Вирок деально пари (2016) дивитися онлайн в хорошй якост 720. Серал Мер 1 сезон (2017) дивитися онлайн в хорошй якост 720. Серал Озеро 1 сезон (2017) дивитися онлайн в хорошй якост 720. Сер
    Вдчайдушн шахраримейком фльму Казки на нч 1964 року з Марлоном Брандо, Девдом Найвеном Ширл Джонс. Зйомки фльму вдбувалися на Французькй Рив’р у департамент Приморськ Альпи: мунципалтететах — Антб, Канни, Боль-сюр-Мер, Сен-Жан-Кап-Ферра, Нцца та Вльфранш-сюр-Мер.
    Пастка Офцйний укранський трейлер2017 Трейлери укранською. Крс отриму запрошення погостювати вд батькв сво двчини. Згодом хлопець зясову
    Шахрайка поклала х у конверт, затягнула його скотчемстала проводити над ним якийсь загадковий ритуал. При цьому непомтно пдмнила конверт на порожнй, який тримала в кишен. За новий сеанс цлителька взяла тисячу гривень, а конверт (ясна рч, уже без грошей) вддала господин, сказавши до завтра його не вдкривати.
    Так двох абсолютно рзних двчат об’дну спльна дяльнстьвони шахрайки. Тльки ось одна з них ще аматор у цй нелегкй справ, поки не ма розвинених навикв, а тому й амбц у не маленьк. Але ось ншариба абсолютно ншого рвня, з ншими цлями, бажаннями та можливостями. Але разом у цих двох вдчайдушних може вийти працювати ще ефективнше, отримуючи все бльше грошей. Хто би запдозрив цих красунь хоч у чомусь? Поки ще нхто не оцнював 12:25 13:10 15:10 17:10. 19:10. 20:00. 21:00. 22:00. 23:00. 00:10. Кнотеатр Кнопалац. вулиця Театральна, 22. 10:00 14:30 19:20. 21:30. нш фльми зараз.
    Рад втати Вас на сторнц Харквсько спецалзовано школи87. У навчальному заклад визначена укранська мова навчання. Загальна кльксть класв – 27 Загальна кльксть педагогчного колективу – 50 Загальна кльксть учнв – 739. 61177 м. Харкв вул. Башкирська, 2 тел. 372-19-24 372-19-16. офцйний сайт school87 електронна пошта school87.
    Знаходиться 50 м до . Загальна площа 36 сотих.парковка. В будиночках гаряча вода, сан. вузли, чиста близна, посуд, холодильник в кожному номер. Будиночки на 3-4 Подробнее. Вдпочинок на Днстр Старая Ушица. Здаються затишн кмнати для вдпочинку на берез Днстра.
    90-х. 80-х. 70-х. 1960-хранш. 2019. 2018. 2017. 2016. Найкращ бойовики у високй якост. Дивитися онлайн безкоштовно. За популярнстю Нов спочатку За зборами За бюджетом Найкращ. Сортувати Скарби Сьрра-Мадре (1948). бойовики. вйськов фльми. драми. комед.
    Час сеансв: 10:00. Сюжет: Вллзвичайний хлопчик з Земл, який ось уже деякий час разом з своми батьками борознить простори космосу Так двох абсолютно рзних двчат об’дну спльна дяльнстьвони шахрайки. Тльки ось одна з них ще аматор у цй нелегкй справ, поки не ма розвинених навикв, а тому й амбц у не маленьк. Але ось ншариба абсолютно ншого рвня, з ншими цлями, бажаннями та можливостями. Але разом у цих двох вдчайдушних може вийти працювати ще ефективнше, отримуючи все бльше грошей. Хто би запдозрив цих красунь хоч у чомусь? Купити Забронювати.
    Замовлення Витягу про земельну длянку та Витягу про нормативну грошову оцнку через нтернет. Перегляд нформац про власника земельно длянки
    Дв заповзятлив лед беруться до справи з подвйною Шахрайки з Ребел Влсон та Енн Гетевей у головних роляхце рмейк комед 1988 року Вдчайдушн шахра з чоловками у головних ролях. Фльм 88-го року у свою чергурмейком комед 1964 року. Про проект, що адаптував би вдомий сюжет для жночих персонажв, вперше заговорили у 2016 23-29 травня. Четвер-середа. 10:00. Фльм “Шахрайки” (16+). Кнотеатр “Планета”, зал “Червоний”, вул. Подльська, 39. 20:00. Фльм “Шахрайки” (16+). Кнотеатр “Планета”, зал “Синй”, вул. Подльська, 39. комедя кримнал кнотеатр “Планета”.
    Дивться онлайн шоу Холостяк 9 сезон 3 випуск вд 22. на телеканал СТБ! На третьому тижн проекту мж холостяком та його обраницями нароста градус емоцй. Але чи зможуть ревнощ перешкодити пристраст, яка поглине холостяка на цьому тижн? Вже третй тиждень поспль двчата невтомно прокладають шлях до серця чарвного Нкти Добринна. Деяк подружилися з друзями Нкти, нш пдкорюють смачною жею, екстримомсексуальнстю. На проект красун намагаються спровокуватирозчулити, але найголовншекожна з двчат прагне уваги.вже сьогодн в 3 випуску шоу Холостяк 2019 Нкта Доб
    Дивться онлайн серал “Вдчайдушний домогосподар” (2017) безкоштовно в хорошй якост (HD). Останн епзоди на сайт телеканалу “Украна” субота, 23 вересня 2017, 21:00. Тс “Вдчайдушний домогосподар” (4 серя). 49:14 субота, 23 вересня 2017, 19:00. субота, 23 вересня 2017, 19:00. Тс “Вдчайдушний домогосподар” (3 серя). 49:29 субота, 23 вересня 2017, 18:00. субота, 23 вересня 2017, 18:00. Тс “Вдчайдушний домогосподар” (2 серя). 49:09 субота, 23 вересня 2017, 17:00. субота, 23 вересня 2017, 17:00. Тс “Вдчайдушний домогосподар” (1 серя). Новини проекту Канал Украна покаже комедйну мелодраму Вдчайдушний домогосподар.
    Де дивитися серал Чорнобиль вд HBO в хорошй якост ср, 22 травня, 17:00 19. Чому новий серал Чорнобиль вд HBO викликав масовий ажотаж. Драматичний мн-серал про трагедю в Чорнобил став одню з грандозних прем’р року. Кадр з мн-сералу Чорнобиль. фото: imdb Творцемодним з виконавчих продюсерв сералу став Крейг Мазн, вдомий завдяки робот над 3-ю4-ю частинами комед Дуже страшне кно, Пймай шахрайку, якщо зможеш. Режисером проекту став Юхан Ренк, який створював вдеоклпи для Мадонни, Бейонсе, Кайл Мноуг, Девда Боунших легенд шоу-бзнесу Де дивитися 5 епзод 8 сезону сералу Гра престолв: трейлер. 10 травня, 23:46. Кно.
    Розлучення по-американськи – це “розлучення” на грош. Варто тльки витерти сльозиза допомогою хитрого хлопця з адвокатсько контори “розвести” колишн

    Схожі ключі:
    Шахрайки трейлер російською
    кіно Шахрайки 2019
    кіно Шахрайки
    Шахрайки скачати торрент в хорошій якості
    Шахрайки фiльм 2012, щоб спостерігати онлайн
    Шахрайки онлайн в хорошій якості
    Шахрайки 2019 дивитися онлайн в хорошій якості
    Шахрайки скачати
    Шахрайки фiльм 2019 прем’єра
    Шахрайки дивитися фiльм онлайн
    Шахрайки дивитися онлайн 2019 трейлер

    Хіти прокату:


  2. I am now not positive the place you’re getting your information, however great topic.
    I needs to spend a while learning much more
    or understanding more. Thanks for great information I used to be in search of this
    information for my mission.

  3. Avatar gotrangtri says:

    Spot on with this write-up, I honestly think this web site needs a lot more attention. I’ll
    probably be returning to read through more, thanks for the info!

  4. Avatar webpage says:

    Heyaa i am for the primary time here. I found this board and I in findinng It realy helpful & it helped me out a
    lot. I am hoping to provide one thing again and
    aid others such as you aided me.

    • Iranian Surgery Adviser Iranian Surgery Adviser says:

      thank you so much for your kind support. One of the main responsibilities of Iranian surgery is to carefully examine patients’ concerns and try to mitigate them before entering Iran. Moreover, our responsibility is not only to select, introduce and connect you to the best Iranian surgeons and hospitals, but also to examine the type of illness and patient expectations case by case. We strive to have effective supervision over every detail of your treatment process even after your course of treatment will be completed and remember that our top priority is to offer high quality healthcare services to international patients. We just work for patients and do not belong to any medical center in Iran.

  5. Avatar DymnDosse says:

    Conception prostatitis, purchase soranib 50mg tablets


    Low prices and discounts – Visit Today!

    sperm benign prostatic hyperplasia
    purchase buying soranib online europe
    discount soranib buy
    canadian doctor soranib order
    to order soranib
    order soranib payment europe
    generic soranib online
    generic discount
    cheapest soranib order california
    cheap generic jobs soranib uk
    buy cheap soranibfloxacin
    soranib price drop in Katowice
    soranib price comparison uk
    soranib buy shopping california
    buying soranib storm in australia
    gastric reflux diet with
    price of soranib pack
    price with soranib canada amex
    soranib 2mg prescription online
    schizophrenia famous cases
    editing soranib approved australia cost
    order soranib squeeze cost
    price review
    purchase soranib store florida in Bridgeport
    cheap soranib overtime 150 mg
    cheapest pharmacy for soranib intel
    diabetes urteil
    soranib someone secure otc
    buy slap soranib quick delivery
    buy canada
    buy legit soranib suffering
    buying bums soranib in uk
    soranib online generic
    order cheap identification soranib
    interrogation beg soranib 20mg buy
    order soranib bars online
    order soranib ruthless sales
    purchase producer soranib shop otc
    PharmacyChecker consultants reply client questions related to affording decrease-cost, prescription medicines. Nonetheless, different public well being experts say that at this significant second, when the world still has a chance to slow the transmission of the coronavirus, any number of toes is simply too shut. But it has turn out to be increasingly clear that individuals with out signs can also infect others In some circumstances, these folks may later really feel terrible sufficient to try to get tested , isolate themselves, search treatment and notify buddies and colleagues about potential threat. Purchase soranib australia visa. Purchase soranib nevada.What stores do price match with Amazon? Here are ten brick-and-mortar stores that will match lower prices found on Amazon: JCPenney. The deal: The department store’s lowest price guarantee ensures that you always get your “penney’s” worth. Target. Lowe’s. Dick’s Sporting Goods. Best Buy. Bed Bath & Beyond. Nordstrom. Walmart.
    Does Walmart take out life insurance policies on their employees? Walmart got the money when 132 Florida employees enrolled in a corporate-owned life insurance program died. When a company names itself a beneficiary on a policy bought in the name of a rank and file employee, it is known as Dead Peasants Insurance. Walmart stopped the practice in 2000, saying it was losing money.
    What is the drug ruxolitinib used for? Ruxolitinib works by blocking certain enzymes in the body that affect blood cell production. Ruxolitinib is used to treat myelofibrosis or polycythemia vera, which are bone marrow disorders that that affect your body’s ability to produce blood cells.

  6. Neat blog! Is your theme custom made or did you download it from somewhere?
    A design like yours with a few simple tweeks would really
    make my blog shine. Please let me know where you got your theme.
    With thanks

  7. I have been surfing online more than 3 hours today, yet I never
    found any interesting article like yours. It’s pretty worth enough for me.
    Personally, if all webmasters and bloggers made good content as you did, the internet will be much
    more useful than ever before.

  8. Avatar Edmund says:

    I am in fact happy to read this website posts which contains tons of helpful facts, thanks for providing such

  9. Avatar Tagpacker says:

    I go to see day-to-day some sites and sites to read content,
    except this web site presents feature based writing.

  10. Avatar qwedfqwewq says:

    If you want to get much from this piece of writing then you have to apply these strategies to
    your won website.

  11. I am really loving the theme/design of your weblog.

    Do you ever run into any web browser compatibility problems?
    A handful of my blog visitors have complained about my website not working
    correctly in Explorer but looks great in Chrome. Do you have any tips to help fix this

  12. Avatar remont cameo says:

    Sweet blog! I found it while searching on Yahoo News.
    Do you have any tips on how to get listed in Yahoo News?
    I’ve been trying for a while but I never seem to get there!

  13. Avatar lifestyle says:

    You really make it seem so easy with your presentation but I find this
    topic to be actually something which I think I would never
    understand. It seems too complicated and very broad for me.
    I am looking forward for your next post, I’ll try to get the hang of it!

  14. Avatar Cleaning says:

    Thanks for finally talking about > Deep vein thrombosis |
    Iranian Surgery < Liked it!

  15. Avatar Agen Judi says:

    Aw, this was an incredibly nice post. Spending some
    time and actual effort to produce a great article… but what can I say…
    I procrastinate a whole lot and never manage to get anything done.

Leave a Reply

Your email address will not be published. Required fields are marked *

قبول المرضي خلال الکورونا