Dvt

Deep Vein Thrombosis Definition Deep vein thrombosis is a condition in which a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis is a serious condition because a blood clot that has formed in your vein can break loose and travel to your lungs. This is called a pulmonary (lung) embolism. In severe cases, a pulmonary embolism can cause death. However, many instances of deep vein thrombosis disappear on their own. Blood clots can also form in veins that are closer to the surface of your skin. But these clots — known as superficial venous thrombosis, phlebitis or thrombophlebitis — aren't typically dangerous because clots that form in the veins near the surface of the skin don't travel to your lungs. Deep vein thrombosis — abbreviated DVT — can cause symptoms, such as leg pain, but often occurs without any symptoms. Deep vein thrombosis can have many causes, such as prolonged sitting or an inherited blood-clotting disorder that increases your risk of DVT. Recognize the symptoms and risk factors for deep vein thrombosis so that you can avoid serious complications of this disorder.

Symptoms It's not uncommon for deep vein thrombosis to occur with no symptoms. In fact, in about half of all cases, there are no noticeable symptoms. When signs and symptoms of deep vein thrombosis do occur, they can include:    

Swelling in the affected legs; this can include swelling in your ankles and feet. Pain in your legs; this can include pain in your ankles and feet. This pain often starts in your calf and can feel like cramping or a "charley horse." Redness and warmth over the affected area. Pain or swelling in your arms or neck. This can occur if a blood clot forms in your arms or neck.

Deep vein thrombosis and pulmonary embolism warning signs Sometimes the first sign of deep vein thrombosis can be the chest pain associated with a pulmonary embolism. If this is the case, seek medical help immediately. The warning signs and symptoms of a pulmonary embolism include:     

Chest pain or discomfort. This pain or discomfort usually gets worse when you take a deep breath or when you cough. Unexplained sudden onset of shortness of breath. This is the most common symptom. Feeling lightheaded or dizzy, or fainting. Coughing up blood. A sense of anxiety or nervousness.

Causes Deep vein thrombosis occurs when a blood clot forms in the veins that are deep in your body, often in your legs. Blood clots can be caused by many different things — namely anything that causes your blood not to circulate or clot properly.

Risk factors Many factors can increase your risk of developing deep vein thrombosis. One of the more talked about risks is sitting for a long time, such as when traveling in a car or on an airplane. Blood clots can form in the calves of your legs if your calf muscles aren't moving. Although sitting for long periods is a risk factor, your chance of developing deep vein thrombosis while flying or driving is relatively low. The risk factors for developing deep vein thrombosis include: 





Sitting for long periods of time, such as when driving or flying. When your legs remain still for long periods, your calf muscles don't contract, which normally helps blood circulate. As a result, blood clots can develop. Inheriting a blood-clotting disorder. Some people inherit a disorder that makes their blood clot more easily. This inherited condition may not cause problems unless combined with one or more other risk factors. Prolonged bed rest, such as during a long hospital stay, or paralysis. When your legs remain still for long periods, your calf muscles don't contract to help blood circulate. As a result, blood clots can develop.











  

 

Injury or surgery. Injury to your veins or surgery can slow blood flow, increasing the risk of blood clots. General anesthetics used during surgery can dilate your veins, which can increase the risk of blood pooling and then clotting. Pregnancy. Pregnancy increases the pressure in the veins in your pelvis and legs. Women with an inherited clotting disorder are especially at risk. The risk of blood clots from pregnancy can continue for up to six weeks after you give birth. Cancer. Some forms of cancer increase the amount of substances in your blood that promote clotting. In addition, some forms of cancer treatment increase the risk of blood clots. Heart failure. People with heart failure are at risk of DVT because a damaged heart doesn't pump blood as effectively as a normal heart does. This increases the chance that blood will pool and clot. Birth control pills or hormone replacement therapy. Oral contraceptives (birth control pills) and hormone replacement therapy both can increase your blood's ability to clot. A pacemaker or a thin, flexible tube (catheter) in a central vein. These medical treatments can irritate the blood vessel wall and decrease blood flow. A history of deep vein thrombosis or pulmonary embolism. If you've had DVT before, you're more likely to have DVT in the future. A family history of deep vein thrombosis or pulmonary embolism. If someone in your family has had DVT or a pulmonary embolism, your risk of developing DVT is increased. Being overweight or obese. Being overweight increases the pressure in the veins in your pelvis and legs. Smoking. Smoking affects blood clotting and circulation.

When to seek medical advice If you develop signs or symptoms of deep vein thrombosis, contact your doctor for guidance. If you develop signs or symptoms of a pulmonary embolism — such as chest pain or discomfort — seek medical attention immediately. The warning signs of a pulmonary embolism include:     

Chest pain or discomfort. This pain or discomfort usually gets worse when you take a deep breath or when you cough. Unexplained shortness of breath. This is the most common symptom. Feeling lightheaded or dizzy, or fainting. Coughing up blood. A sense of anxiety or nervousness

Tests and diagnosis To diagnose deep vein thrombosis, your doctor will ask you a series of questions about your symptoms. A physical exam will also be performed to examine any areas

of swelling, tenderness or discoloration on your skin. Depending on how likely you are to have a blood clot, your doctor may suggest further testing, including: 







Ultrasound. A wand-like device (transducer) placed over your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect back, a computer transforms the waves into a moving image on a video screen. A clot may be visible in the image. Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is growing or to be sure a new one hasn't developed. CT or MRI scans. Both computerized tomography (CT) and magnetic resonance imaging (MRI) can provide visual images of your veins and may show if a clot is present. Sometimes a venous thrombosis is found when these scans are performed for other reasons. Blood test. Almost all people who develop severe deep vein thrombosis have an elevated blood level of a clot-dissolving substance called D dimer. However, D dimer is elevated in other conditions, too. Thus, a test for D dimer is not very conclusive. Currently, it's most useful for ruling out deep vein thrombosis or for identifying people at risk of recurrence. Venography. A dye (contrast agent) is injected into a large vein in your foot or ankle. An X-ray procedure creates an image of the veins in your legs and feet, to look for clots. This test is used less frequently today because less invasive studies can usually confirm the diagnosis.

Complications The primary complication to be concerned with in deep vein thrombosis is a pulmonary embolism. A pulmonary embolism occurs when an artery in your lung becomes blocked by a blood clot (thrombus) that travels to your lungs from another part of your body, usually your leg. A pulmonary embolism can be fatal. So, it's important to be on the lookout for signs and symptoms of a pulmonary embolism and seek medical attention if they occur. Signs and symptoms of a pulmonary embolism include:     

Chest pain or discomfort. This pain or discomfort usually gets worse when you take a deep breath or when you cough. Unexplained shortness of breath. This is the most common symptom. Feeling lightheaded or dizzy, or fainting. Coughing up blood. A sense of anxiety or nervousness.

A common complication that can occur after deep vein thrombosis is a condition known as postphlebitic syndrome, also called post-thrombotic syndrome. This syndrome is used to describe a collection of signs and symptoms you may have, including swelling of your legs (edema), pain and skin discoloration. This syndrome is caused by damage to your veins from the blood clot. This damage reduces blood flow in the affected areas. The symptoms of postphlebitic syndrome may not occur until a few years after the DVT. Treatment options include medications such as aspirin or diuretics, as well as the use of compression stockings.

Treatments and drugs The goals of deep vein thrombosis treatment are to stop your blood clot from getting any bigger, to prevent the clot from breaking loose and causing a pulmonary embolism, and to prevent deep vein thrombosis from happening again. Deep vein thrombosis treatment options include: 

Blood thinners. Medications used to treat deep vein thrombosis include the use of anticoagulants, also sometimes called blood thinners, whenever possible. These are drugs that decrease your blood's ability to clot. While they don't break up existing blood clots, they can prevent clots from getting bigger or reduce your risk of developing additional clots. Typically, you'll first be given an injection of the anticoagulant heparin for a few days. There are two main forms of heparin, low-molecular-weight heparin and unfractionated heparin. Recent guidelines suggest low-molecular-weight heparin is usually the best treatment option. After heparin injections, your treatment may be followed by another anticoagulant in pill form, likely warfarin. You may need to take anticoagulants for three months or longer. The use of heparin and warfarin must be closely monitored because both can have side effects, such as an increased risk of bleeding. On the other hand, if your dose is too low, you're at increased risk of additional blood clots. To monitor the effects of blood thinners, you will need periodic blood tests to check how long it takes your blood to clot. Pregnant women should not take warfarin.







Clotbusters. If you have a more serious type of deep vein thrombosis or pulmonary embolism, or if other medications aren't working, your doctor may try other medications. One group of medications is known as thrombolytics. These drugs, such as tissue plasminogen activator (tPA), are given intravenously to break up blood clots. These drugs can cause serious bleeding and are typically used only in life-threatening situations. Filters. If you can't take medicines to thin your blood, a filter may be inserted into a large vein — the vena cava — in your abdomen. This filter prevents clots that break loose from lodging in your lungs. The filters are sometimes referred to as "umbrellas" because they look like the wire spokes of an umbrella. Compression stockings. These help prevent swelling associated with deep vein thrombosis. These stockings are worn on the leg from your foot to about the level of your knee. This pressure helps reduce the chances that your blood will pool and clot. You should wear these stockings for at least a year if possible.

Prevention Preventing deep vein thrombosis is far easier than treating it after it has occurred. Some common preventive measures include the following: 

Take any prescribed medications as directed. If you're having surgery, such as orthopedic surgery, you'll probably be given blood thinners while you're in the hospital.

 

  



Check in with your doctor regularly to see if your medication or treatments need to be modified. If you take blood thinners (anticoagulants), watch your intake of vitamin K, which can affect how drugs like warfarin work. Foods high in vitamin K include green leafy vegetables and canola and soybean oils. Exercise your lower calf muscles if you'll be sitting a long time. Whenever possible, get up and walk around. Move. If you've been on bed rest, because of surgery or other factors, the sooner you get moving, the less likely blood clots will develop. Make lifestyle changes. Lose weight, quit smoking and control your blood pressure. Obesity, smoking and high blood pressure all increase your risk of deep vein thrombosis. Wear compression stockings to help prevent blood clots in the legs if your doctor recommends them.

Lifestyle and home remedies The primary goal of your self-care plan should be preventing deep vein thrombosis from occurring. To prevent deep vein thrombosis:   

  

 

Take any prescribed medications as directed. Check in with your doctor regularly to see if your medication or treatments need to be modified. If you take blood thinners (anticoagulants), watch your intake of vitamin K, which can affect how drugs like warfarin work. Foods high in vitamin K include green leafy vegetables and canola and soybean oils. Exercise your lower calf muscles if you'll be sitting a long time. Whenever possible, get up and walk around. Move. If you've been on bed rest, because of surgery or other factors, the sooner you get moving, the less likely blood clots will develop. Make lifestyle changes. Lose weight, quit smoking and control your blood pressure. Obesity, smoking and high blood pressure all increase your risk of deep vein thrombosis. Wear compression stockings to help prevent blood clots in the legs if your doctor recommends them. Be on the lookout for excessive bleeding, which can be a side effect of taking medications such as blood thinners.