DVT (Deep vein thrombosis)

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 lower legs, thighs, pelvis and sometimes in the arms. Deep vein thrombosis can cause pain or swelling, but also can occur with no symptoms.

Deep vein thrombosis can develop with certain medical conditions that affect how the blood clots. It can also happen if you don't move for a long time, such as after surgery or an accident, or when confined to bed.

Even though DVT itself is not life-threatening, the blood clot has the potential to break free and travel through the bloodstream, where it can become lodged in the blood vessels of the lung (known as a pulmonary embolism). This can be a life threatening condition requiring prompt diagnosis and treatment.

Signs & Symptoms can include:

• Swelling in one or possibly both legs, although there's rarely swelling in both legs.
  • If the vein swells, the condition is called thrombophlebitis.
• Pain in the leg.
  • The pain often starts in the calf and can feel like cramping or soreness.
  • It may occur just when you stand or walk
• Red or discolored skin on the leg.
• A feeling of warmth in the affected leg.
• Veins seen are swollen, red, hard or tender to the touch
• Deep vein thrombosis can occur without noticeable symptoms.

Causes:

The blood clots of deep vein thrombosis can be caused by anything that prevents your blood from circulating or clotting normally, such as injury to a vein, surgery, certain medications and limited movement.

Complications

If there is a clot in a deep vein, there is risk for damage to the veins and organs as well as other life-threatening problems. Not everyone who gets DVT will have trouble.

1.) Pulmonary Embolism (PE): (See: Embolism)

• The most common cause of a pulmonary embolism is a DVT.
• If the blood clot comes loose from the vein and moves through the bloodstream, it can end up partly or completely blocking an artery in the lungs. This can happen right after the clot forms or it may happen later.
• About 1 in 10 people with deep vein thrombosis will have a PE. That number may actually be much higher, though, because some people have no symptoms and go undiagnosed.
• If you develop signs or symptoms of a pulmonary embolism — a life-threatening complication — Seek Immediate Medical Attention.
  • The warning signs and symptoms of a pulmonary embolism include:
    • Sudden shortness of breath
    • Sharp chest pain, tightness or discomfort that worsens when taking a deep breath or coughing
    • Feeling lightheaded or dizzy, or fainting
    • Rapid pulse
    • Suddenly coughing up blood
    • Pain in the shoulder, arm, back or jaw
    • Pain when breathing
• PE can lead to serious problems, including:
  • Irregular heartbeat (heart palpitations)
  • Heart failure, when your heart can't keep up with the body's demands
  • Trouble breathing
  • High blood pressure in the lungs, called pulmonary hypertension
  • Sudden death in up to 1 in 4 people with a PE

2.) Postthrombotic Syndrome or Chronic Venous Insufficiency (aka: Postphlebitic syndrome)

• When a clot stays in the leg or arm for too long, it can damage the vein or its valves. Valves that don't work right let blood flow backwards and pool, instead of pushing it toward the heart.
• Post-thrombotic syndrome is usually mild, but some symptoms can be severe. They may not show up until years later.
• Up to half of people with DVT end up with long-term effects where the clot was and will have:
  • Leg pain
  • Persistent swelling of legs (edema)
  • Darkened skin color
  • Skin sores
  • Varicose veins -- swollen, sometimes twisted or blue veins you can see under the skin
• Because blood isn't flowing well, it is more likely to clot, increasing the chance of get another DVT or a pulmonary embolism.

Risk factors:

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

• Prior history of a blood clot.
  • About 30% of people who’ve had DVT will have it again.
• A family history
  • If a parent or sibling had DVT, the risk increases; if both parents have been diagnosed, the chances may be even higher.
• Age.
  • Being older than 60 increases your risk of DVT, though it can occur at any age.
  • Another site stated over 40 years.
• Prolonged bed rest or sitting (such as when driving or flying).
  • The deep veins in the center of the legs depend on the muscles to force blood back to the lungs and heart. If the muscles don’t move for a while, blood starts to pool in the lower legs, making it more likely for a clot to form.
• Pregnancy.
  • When expecting a baby, levels of the female hormone estrogen rise. This causes the blood to clot more easily.
  • 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 delivery.
• Birth control pills (oral contraceptives) or hormone replacement therapy,
  • Chances of DVT goes up when on these, because many of these drugs contain estrogen, which increases the blood’s ability to clot.
• Inheriting a blood-clotting disorder -- blood doesn’t clot like it should.
  • Inheriting a disorder that makes the blood clot more easily on its own might not cause blood clots unless combined with one or more other risk factors.
  • Or it can cause the blood to be thicker than normal when it moves through the body, which increases the potential for clots.
• Being overweight or obese.
  • This increases the pressure in the veins in the pelvis and legs.
  • The higher the body mass index (BMI), the greater the risk for DVT. BMI measures how much fat you have compared to your height and weight.
• Having other health issues.
  • People with heart disease, lung disease, varicose veins and inflammatory bowel disease are more likely to get DVT.
  • Some forms of cancer increase substances in the blood that cause it to clot. Some forms of cancer treatment also increase the risk of blood clots.
• Injury or surgery.
  • If a muscle is badly injury or a bone is fractured, the inner lining of a nearby vein could have been damaged.
  • Major surgery to your stomach, pelvis, hip, or leg (esp. in first 2-10 days after surgery)

How to lower risk

• Avoid prolonged sitting.
  • Get up and stretch or walk around at least every 2 hours. It can also help to move the legs while seated.
  • Do seated exercises, such as leg raises, tightening and loosening leg muscles and doing heel & toe lifts
• Get moving as soon as you can after surgery.
  • Even doing simple leg lifts in bed will help keep blood flowing through your veins.
• Talk to your doctor.
  • If you think you’re at risk for DVT, your doctor might advise you to take blood thinners. These are drugs that help prevent clots. He may also suggest that you wear compression stockings. These stockings fit tightly around your ankle but become looser as they go up your leg. They make it harder for blood to pool in your legs.
• Plan your travel.
  • If you know you’ll be sitting on a train, plane, or in a vehicle for a while, stand up often and stretch your legs or do foot/ankle exercises. Make sure to wear loose clothing. Drink lots of water and avoid alcohol. If your body doesn’t have enough fluid, your blood vessels narrow and clots are more likely to form.
• Stay active.
  • Regular exercise lowers your chances of getting a blood clot. Even walking can help.
• Take care of your health.
  • That may mean losing weight or giving up smoking. If you have heart disease, diabetes, or another chronic illness, follow your doctor’s orders to manage these health issues.

Diagnosis

• History & Physical exam
• Possible tests might include: ultrasound, blood tests, venography, CT or MRI scans

Treatment

• Treatment includes medicines to ease pain and inflammation, break up clots and keep new clots from forming or getting bigger and preventing the clot(s) from breaking loose and causing a pulmonary embolism. Then the goal becomes reducing your chances of deep vein thrombosis happening again.
• Treatment options may include: Blood thinners (anticoagulants), clot busters, inferior vena cava filters, compression stockings

Statistics

• The Centers for Disease Control and Prevention (CDC) estimate that DVT, PE or both might affect up to 900,000 people in the United States each year.
• DVT and PE are more likely to affect women of childbearing age than men of the same age.
• After menopause, women have a lower risk for DVT and PE than men, but anyone can have DVT and PE.
• From: CDC - Venous thromboembolism (blood clots)
  • The precise number of people affected by DVT/PE is unknown, although as many as 900,000 people could be affected (1 to 2 per 1,000) each year in the United States.
  • Estimates suggest that 60,000-100,000 Americans die of DVT/PE (also called venous thromboembolism).
    • 10 to 30% of people will die within one month of diagnosis.
    • Sudden death is the first symptom in about one-quarter (25%) of people who have a PE.
  • Among people who have had a DVT, one-half will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb.
  • One-third (about 33%) of people with DVT/PE will have a recurrence within 10 years.
  • Approximately 5 to 8% of the U.S. population has one of several genetic risk factors, also known as inherited thrombophilias in which a genetic defect can be identified that increases the risk for thrombosis.

Resources & Additional Reading:

• Mayo Clinic - Deep vein thrombosis (DVT)
• WebMD - Deep Vein Thrombosis Health Center
• Medical News Today - Deep vein thrombosis and pulmonary embolism. By: Jenny Fitzgerald, Reviewed by Stacy Sampson, DO. Updated 26 Sep 2018
• Medline Plus - Deep Vein Thrombosis
• MedicineNet - 7 DVT (Blood Clot in the legs) Symptoms, Signs, and Treatment Guidelines
• Cleveland Clinic - Deep Vein Thrombosis (DVT)

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