Deep Vein Thrombosis
by Maryam Abdul-Jalil and Omar Bhatti
Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs. Deep vein thrombosis can cause leg pain or swelling, but may occur without any symptoms.
Causes of DVt
- Surgery that reduces blood flow to a part of your body
- Major surgery on a hip, knee, leg, calf, abdomen, or chest
- Orthopedic surgery, such as hip replacement
- An injury that reduces blood flow to part of your body, such as a broken hip or leg
- Cancer, even during treatment
- A previous history of deep vein thrombosis or pulmonary embolism
- An inherited condition that increases blood clotting
- Paralysis from a spinal cord injury
- Current use of hormone therapy, including that used for postmenopausal symptoms, especially in smokers
- Pregnancy or having recently given birth, especially by C-section
- Varicose veins, which are swollen, twisted, painful veins
- A history of heart attack, stroke, or congestive heart failure
- Inflammatory bowel disease
- Sitting or inactivity for a long time
- Long plane flights or long car trips
- Extra weight
- Current use of birth control pills or patches
Symptoms of dvt
- Pain or tenderness in one or both legs, which may occur only while standing or walking
- Swelling in one or both legs
- Warmth in the skin of the affected leg
- Red or discolored skin in the affected leg
- Visible surface veins
- Leg fatigue
- Many times there are no symptoms!
How is dvt diagnosed?
Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, a physical exam, and test results. He or she will identify your risk factors and rule out other causes of your symptoms.
When asking about your medical history, your doctor will ask about your overall health, and prescription medicines you're taking, any recent surgeries you have had, whether you have been treated for cancer
For the physical exam, your doctor will check your legs for signs of DVT, such as swelling or redness. Your blood pressure will also be checked as well as your heart and lungs
The most common test for diagnosing deep vein blood clots is an ultrasound and other tests used are an MRI or CT scan
Approximately 1 out 1000 of adults will suffer from DVT. Rates are slightly higher in med than in women.
How Can it be prevented?
- By maintaining an active healthy lifestyle
- Maintaining your weight
- Not smoking
- Getting your blood pressure checked regularly
- Discussing alternatives to birth control pills or hormone-replacement therapy to your doctor
- If you are on an airplane for more than 4 hours, either walk or do leg stretches in your seat. Also stay well-hydrated and avoid alcohol consumption
- Heparin: People with DVT may receive heparin intravenously or by injection in the hospital for several days. You may also continue the injections at home, once or twice daily. Intravenous heparin requires blood testing, but subcutaneous (under the skin) injections of low molecular weight heparin do not.
- Warfarin: As a DVT treatment, you take warfarin (Coumadin) by pill once a day, beginning while you're still on heparin. Treatment may continue for three to six months or more. While on warfarin, you will need regular blood tests to ensure you have the correct dosage -- too little increases your clot risk, too much increases your risk for bleeding. Warfarin can also interact with other medicines, vitamins, or certain foods rich in vitamin K -- making regular monitoring even more important. If you're pregnant, your doctor will prescribe other types of treatment, because warfarin can cause birth defects.
- Xarelto: Unlike warfarin, Xarelto does not require monitoring with blood tests. It's also less likely than warfarin to cause serious bleeding. You also do not need to worry about interactions with foods with Xarelto. The downside is that it's much more expensive than warfarin.
- Pradaxa: Pradaxa is an oral anticoagulant that works by blocking a certain substance (a clotting protein called thrombin) in your blood. This helps to keep blood flowing smoothly in your body.
- Eliquis: Called a selective Factor Xa inhibitor, this oral anticoagulant has also been approved to prevent strokes in some people. Usually taken twice a day, Eliquis can cause nausea, easy bruising, or minor bleeding (such as nosebleed, bleeding from cuts).
- Vena cava filter. This is a small metal device that is temporarily inserted to capture blood clots and prevent them from moving to other areas of your body. The filter allows blood to pass through the vein as it normally would.
- An interventional radiologist or vascular surgeon inserts the filter into the vena cava, which is the main vein going back to the heart from your lower body. To reach this vein, which is in your abdomen, the doctor inserts the filter into a leg, neck, or arm vein. Ask your doctor how long the filter needs to stay in place.
- Elevation and compression. Elevating the affected leg and using a compression device may help reduce symptoms of DVT, such as swelling and pain. Your doctor may also prescribe graduated compression stockings to reduce the risk of recurrence. You wear this DVT treatment from the arch of your foot to just above or below your knee.
- Venous thrombectomy. In very rare cases, surgery is required to remove a deep vein clot. This may be true if you have a severe type of DVT that does not respond well to nonsurgical DVT treatment. This is called phlegmasia cerulea dolens.
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