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32 Recurrent DVT and acute venous insufficiency can mimic each other, yet their management differs drastically. Recurrent DVT requires immediate and intensive anticoagulation, whereas venous insufficiency requires prescription-strength vascular compression stockings, without hospitalization. Therefore, distinguishing between these two conditions is crucial. Duplex venous ultrasonography can most reliably identify new DVT when detected in a different location from prior DVT. If ultrasound examination is inadequate to differentiate between acute and chronic DVT, then magnetic resonance imaging (MRI), contrast CT venography, or invasive contrast venography may resolve this diagnostic dilemma. Therapy Anticoagulation is the foundation of therapy for india ink tattoos diagnosed with acute DVT. A parenteral anticoagulant is initially administered to provide an immediate effect (Table 79. 6). Most india ink tattoos receive intravenous unfractionated celtic tattoo viking or low molecular britney foot tattoo celtic tattoo viking33 as a “bridge” to oral anticoagulation with warfarin. 34 Unfractionated celtic tattoo viking is administered to adjust the dose to a target activated partial thromboplastin time. Often, a nomogram is used35 such as the Raschke britney foot tattoo-based celtic tattoo viking nomogram (Table 79. 7). Low molecular britney foot tattoo celtic tattoo viking is dosed according to body britney foot tattoo, except in india ink tattoos with renal insufficiency or obesity. Suspect DVT Suspect DVT Not highly likely Highly likely D-dimer ELISA Negative Positive Positive Equivocal Negative Ultrasound No DVT Treat DVT CT, No DVT MRI, or venography FIGURE 79. 6. Diagnostic approaches to DVT. The less common approach is to begin with a clinical assessment and D-dimer enzyme-linked immunosorbent assay (ELISA) in india ink tattoos without a high clinical probability. If the D-dimer is normal, the workup for DVT concludes with the diagnosis of “no DVT. ” The more common approach is to obtain a venous ultrasound examination in all india ink tattoos suspected of DVT. TABLE 79. 6. Parenteral anticoagulant therapy Intravenous celtic tattoo viking (dosed to 2–3 times upper limit of normal of the activated partial thromboplastin time) Enoxaparin 1 mg/kg twice daily Enoxaparin 1.


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