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Deep Venous Thrombosis


Deep venous thrombosis (DVT) is a blood clot in the deep veins of the body. DVTs most commonly occur in the legs or pelvis. This condition can be potentially life-threatening if the blood clot breaks off and goes to the lungs.


Causes

Any factor that promotes slow blood flow through the veins, a pro-clotting state, or injury to the vein can lead to a clot in the deep veins. Almost anyone can develop a DVT. 


Risk factors that are associated with DVTs include:

  • Prolonged immobility from for example, bed rest, sitting on long flights or drives

  • Injury to a vein, caused by for example, fracture, major surgery, severe muscle injury

  • Increased estrogen, often caused by birth control pills, hormone replacement therapy Pregnancy and up to six weeks after delivery

  • Smoking

  • Cancer

  • Obesity

  • Heart failure

  • Family history or personal history of blood clots


Symptoms

Roughly half of people with DVT have no symptoms. When they occur, the affected limb symptoms include:

  • Swelling

  • Pain and tenderness

  • Warmth

  • Redness of the skin


If you have these symptoms or think you have a blood clot in your leg, call your doctor as soon as possible.


The potentially serious complication of a DVT is a pulmonary embolism (PE). If the clot breaks off and lodges in the lung, symptoms of PE can include:

  • Shortness of breath or trouble breathing

  • Sharp, knife-like chest pain when you breathe in

  • Chest pain or discomfort

  • Coughing or coughing up blood

  • Lightheadedness or fainting

  • A rapid heartbeat


If you have any of these symptoms, seek medical help immediately.


Diagnosis

In addition to obtaining a clinical picture based on risk factors, symptoms, and physical examination, the doctor may order a blood test and imaging studies such as an ultrasound of the affected limb.


Treatment

The goal of treatment is to prevent the clot from getting bigger and making its way to the lung to cause a pulmonary embolism. 


Treatment strategies include:

  • Anticoagulation. These anti-clotting drugs come in injectable (such as heparin, enoxaparin) and pill form (examples include apixaban, dabigatran, rivaroxaban, and warfarin). They do not dissolve existing blood clots, but they do keep them from getting bigger and keep new blood clots from forming. These drugs need to be taken for 3 months or longer. These medications bide time for the body to dissolve the old clot.

  • Filter. People who can not take anticoagulation drugs might have an inferior vena cava filter inserted into the vein to trap any large clots and keep them from making their way to the lung.

  • Clot buster. A clot that is severe enough to cut off blood supply to the leg or cause a pulmonary embolism may require medicine or thrombolytics to dissolve the clot. In some cases, doctors will do surgery to remove the clot.


Prevention

Some blood clots are preventable. Here are some ways to lower your risk of developing a DVT:

  • Stay active. Avoid long periods of stayings still.

  • Get up and move around every 1 to 2 hours whenever you travel on a plane, train, or bus, especially if the trip is longer than 4 hours

  • Do heel toe exercises or circle your feet if you cannot move around

  • Lose weight, if you are overweight

  • Talk to your doctor about your risk of clotting whenever you take hormones, or during and right after any pregnancy

  • Ask your doctor about need for “blood thinners” or compression stockings whenever you are admitted to the hospital




References

https://www.cdc.gov/ncbddd/dvt/facts.html

https://medlineplus.gov/deepveinthrombosis.html

https://www.uptodate.com/contents/overview-of-the-treatment-of-lower-extremity-deep-vein-thrombosis-dvt

https://www.stoptheclot.org/learn_more/prevention_of_thrombosis/

https://www.heart.org/en/health-topics/venous-thromboembolism/what-is-venous-thromboembolism-vte