Deep vein thrombosis DVT

 

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Deep vein thrombosis DVT

Deep vein thrombosis (DVT)

Overview

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs. Deep vein thrombosis can cause leg pain or swelling. Sometimes there are no noticeable symptoms.

Deep vein thrombosis is a blood clot in a vein located deep within your body, usually in your leg. Get treatment right away so you can prevent serious complications. Treatments include medicines, compression stockings and surgery. Be patient. You may need to take medicine for a few months and wear compression stockings for two years

Deep vein thrombosis (DVT, also called venous thrombosis) occurs when a thrombus (blood clot) develops in veins deep in your body because your veins are injured or the blood flowing through them is too sluggish. The blood clots may partially or completely block blood flow through your vein. Most DVTs happen in your lower leg, thigh or pelvis, but they also can occur in other parts of your body including your arm, brain, intestines, liver or kidney.

You can get DVT if you have certain medical conditions that affect how the blood clots. A blood clot in the legs can also develop if you don't move for a long time. For example, you might not move a lot when traveling a long distance or when you're on bed rest due to surgery, an illness or an accident.

Deep vein thrombosis can be serious because blood clots in the veins can break loose. The clots can then travel through the bloodstream and get stuck in the lungs, blocking blood flow (pulmonary embolism). When DVT and pulmonary embolism occur together, it's called venous thromboembolism (VTE).

 

What is the danger of DVT?

Even though DVT itself is not life-threatening, the blood clots have the potential to break free and travel through your bloodstream. A pulmonary embolism (PE) happens when the traveling blood clots (emboli) become lodged in the blood vessels of your lung. Since this can be a life-threatening condition, you need a quick diagnosis and treatment.

As many as half of those who get a DVT in their legs develop symptoms of intermittent leg pain and swelling that may last months to years. These symptoms are called post-thrombotic syndrome and can happen because of damage to the valves and inner lining of your veins leading to blood “pooling” more than it should. This increases the pressure inside your veins and causes pain and swelling.

Characteristics of this condition include:

• Pooling of blood.
• Chronic leg swelling.
• Increased pressure within your veins.
• Increased pigmentation or discoloration of your skin.
• Leg ulcers known as venous stasis ulcers.

What is the difference between DVT and a superficial venous thrombosis?

A superficial venous thrombosis (also called phlebitis or superficial thrombophlebitis) is when blood clots develop in a vein close to the surface of your skin. These types of blood clots rarely travel to your lungs unless they move from the superficial system into the deep venous system first. While a physician can diagnose superficial vein clots with a physical exam, they can only diagnose DVT with an ultrasound.

How common is deep vein thrombosis?

Each year, approximately 1 to 3 in every 1,000 adults develop a DVT or pulmonary embolism in the United States, and up to 300,000 people die each year as a result of DVT/PE. It’s the third most common vascular disease, behind heart attacks and strokes. Acute DVT/PE can occur at any age, but are less common in children and adolescents and more common in those over the age of 60. More than half of all DVTs happen as a result of being in the hospital from a medical illness or following surgery. The reason why DVTs are more common after a hospital stay is because you’re lying in bed most of the time instead of moving around like you normally would.

 

 

Symptoms

Deep vein thrombosis (DVT) symptoms can include:

·         Leg swelling

·         Leg pain, cramping or soreness that often starts in the calf

·         Change in skin color on the leg — such as red or purple, depending on the color of your skin

·         A feeling of warmth on the affected leg

Deep vein thrombosis can occur without noticeable symptoms.

A DVT usually forms in the veins of your legs or arms. Up to 30%of people with a DVT don’t have symptoms, but sometimes the symptoms are very mild and may not raise concern. The symptoms associated with an acute DVT include:

• Swelling of your leg or arm (sometimes this happens suddenly).
• Pain or tenderness in your leg or arm (may only happen when standing or walking).
• The area of your leg or arm that’s swollen or hurts may be warmer than usual.
• Skin that’s red or discolored.
• The veins near your skin’s surface may be larger than normal.
• Abdominal pain or flank pain (when blood clots affect the veins deep inside your abdomen).
• Severe headache (usually of sudden onset) and/or seizures (when blood clots affect the veins of your brain).

Some people don’t know they have a DVT until the clot moves from their leg or arm and travels to their lung. Symptoms of acute PE include chest pain, shortness of breath, cough with blood, lightheadedness and fainting.

How is DVT diagnosed?

Your healthcare provider will do a physical exam and review your medical history. You’ll also need to have imaging tests.

Tests to diagnose a DVT

Duplex venous ultrasound. This is the most common test for diagnosing a DVT because it is non-invasive and widely available. This test uses ultrasound waves to show blood flow and blood clots in your veins. A vascular ultrasound technologist applies pressure while scanning your arm or leg. If the pressure doesn’t make your vein compress, it could mean there’s a blood clot. If the results of the duplex ultrasound aren’t clear, your provider can use another imaging test

Venography. In this invasive test, your provider numbs the skin of your neck or groin and uses a catheter to inject a special dye (contrast material) into your veins to see if any blood clots are partially or completely blocking blood flow inside your veins. Venography is rarely used nowadays, but sometimes it is necessary

Magnetic Resonance Imaging (MRI) or Magnetic Resonance Venography (MRV). MRI shows pictures of organs and structures inside your body. MRV shows pictures of the veins in specific locations in your body. In many cases, MRI and MRV can offer more information than a duplex ultrasound or CT scan.

Computed tomography (CT) scan is a type of X-ray that shows structures inside your body. Your provider may use a CT scan to find a DVT in your abdomen, pelvis or brain, as well as blood clots in your lung (pulmonary embolism).

If your doctor thinks you may have a genetic or acquired clotting disorder, you may need to have special blood tests. This may be important if:

• You have a history of blood clots that your provider can’t link to any other cause.
• You have a blood clot in an unusual location, such as in a vein from your intestines, liver, kidney or brain.
• You have a strong family history of blood clots.
• You have a family history of a specific genetic clotting disorder.

 

When to see a doctor

If you develop symptoms of DVT, contact your health care provider.

If you develop symptoms of a pulmonary embolism (PE) — a life-threatening complication of deep vein thrombosis — seek emergency medical help.

The warning signs and symptoms of a pulmonary embolism include:

·         Sudden shortness of breath

·         Chest pain or discomfort that worsens when you take a deep breath or when you cough

·         Feeling lightheaded or dizzy

·         Fainting

·         Rapid pulse

·         Rapid breathing

·         Coughing up blood

Causes

Anything that prevents the blood from flowing or properly clotting can cause a blood clot.

The main causes of deep vein thrombosis (DVT) are damage to a vein from surgery or inflammation and damage due to infection or injury.

Risk factors

Many things can increase the risk of developing deep vein thrombosis (DVT). The more risk factors you have, the greater your risk of DVT. Risk factors for DVT include:

·         Age. Being older than 60 increases the risk of DVT. But DVT can occur at any age.

·         Lack of movement. When the legs don't move for a long time, the calf muscles don't squeeze (contract). Muscle contractions help blood flow. Sitting for a long time, such as when driving or flying, increases the risk of DVT. So does long-term bed rest, which may result from a lengthy hospital stay or a medical condition such as paralysis.

·         Injury or surgery. Injury to the veins or surgery can increase the risk of blood clots.

·         Pregnancy. Pregnancy increases the pressure in the veins in the pelvis and legs. The risk of blood clots from pregnancy can continue for up to six weeks after a baby is born. People with an inherited clotting disorder are especially at risk.

·         Birth control pills (oral contraceptives) or hormone replacement therapy. Both can increase the blood's ability to clot.

·         Being overweight or obese. Being overweight increases the pressure in the veins in the pelvis and legs.

·         Smoking. Smoking affects how blood flows and clots, which can increase the risk of DVT.

·         Cancer. Some cancers increase substances in the blood that cause the blood to clot. Some types of cancer treatment also increase the risk of blood clots.

·         Heart failure. Heart failure increases the risk of DVT and pulmonary embolism. Because the heart and lungs don't work well in people with heart failure, the symptoms caused by even a small pulmonary embolism are more noticeable.

·         Inflammatory bowel disease. Crohn's disease or ulcerative colitis increase the risk of DVT.

·         A personal or family history of DVT or PE. If you or someone in your family has had one or both of these conditions, you might be at greater risk of developing DVT.

·         Genetics. Some people have DNA changes that cause the blood to clot more easily. One example is factor V Leiden. This inherited disorder changes one of the clotting factors in the blood. An inherited disorder on its own might not cause blood clots unless combined with other risk factors.

Sometimes, a blood clot in a vein can occur with no identifiable risk factor. This is called an unprovoked VTE.

Complications

Complications of DVT can include:

·         Pulmonary embolism (PE). PE is a potentially life-threatening complication associated with DVT. It occurs when a blood clot (thrombus) in a leg or other body area breaks free and gets stuck in a blood vessel in a lung.

Get immediate medical help if you have symptoms of PE. They include sudden shortness of breath, chest pain while breathing in or coughing, rapid breathing, rapid pulse, feeling faint or fainting, and coughing up blood.

·         Postphlebitic syndrome. Damage to the veins from the blood clot reduces blood flow in the affected areas. Symptoms include leg pain, leg swelling, skin color changes and skin sores.

·         Treatment complications. Blood thinners are often used to treat DVT. Bleeding (hemorrhage) is a worrisome side effect of blood thinners. It's important to have regular blood tests while taking blood-thinning drugs.

Prevention

Lifestyle changes may help prevent deep vein thrombosis. Try these strategies:

·         Move your legs. If you've had surgery or have been on bed rest, try to move as soon as possible. Don't cross your legs while sitting. Doing so can block blood flow.

When traveling, take frequent breaks to stretch your legs. When on a plane, stand or walk occasionally. If you're traveling by car, stop every hour or so and walk around. If you can't walk, do lower leg exercises. Raise and lower your heels while keeping your toes on the floor. Then raise your toes while keeping your heels on the floor.

·         Don't smoke. Smoking increases the risk of DVT.

·         Manage weight. Obesity is a risk factor for DVT. Regular exercise lowers the risk of blood clots. As a general goal, aim for at least 30 minutes of moderate physical activity every day. If you want to lose weight, maintain weight loss or meet specific fitness goals, you may need to exercise more.