Deep Vein Thrombosis

Orthopaedics

A deep vein thrombosis (DVT) is a blood clot that develops in a deep, large vein, usually in the lower leg or thigh. Deep veins pass through the center of the leg and are surrounded by muscles. The clot can cause pain in the leg and lead to serious complications. The clot may occur when the blood moves more slowly than normal. The clot can interfere with blood circulation and may break off and travel through the blood stream, becoming an embolism (blood clot).

The resulting embolus can lodge in the brain, lungs, heart or other area, causing severe damage to that organ. Normal blood clotting occurs outside the blood vessel and is a normal process which protects the body against losing blood. If you cut your finger and put pressure on the cut, the blood clots and the bleeding stops.

Risks for DVT

Prolonged sitting, bed rest or lack of movement (such as on long plane or car trips)
Recent surgery or trauma (especially hip, knee or pelvic surgery), fractures
Childbirth within the last six months
Use of medications such as estrogen or birth control pills
Malignant tumors, inherited conditions
It is most common in adults over age 60 but can occur in any group
Varicose veins
Stroke, congestive heart failure
Smoking

Symptoms

About half of the people with DVT have no symptoms until a clot blocks a major vein and obstructs blood flow. Symptoms may include:

Leg pain or tenderness in one leg only
A swelling or redness in the calf ankle foot or thigh
Increased warmth in the leg
Bluish discoloration of the skin on the leg or toes

Diagnosis

Your doctor will ask about your medical history and your symptoms. He/she will examine you, especially any abnormal areas, such as a swollen leg. Tests are needed to confirm the diagnosis. The most common tests are:

IPG (impedance plethysmography) - a pressure cuff is placed on your arm or leg to measure how fast the veins empty.
Duplex ultrasound - uses signals to make pictures. The ultrasound bounces sound waves off the deep veins in an arm or leg. The pictures help locate the blockages. It also measures how fast the blood flows through the veins.
Contrast venograpyhy - A dye is injected into the vein while x-ray pictures are being taken. It usually shows the blockage. A CT scan can discover clots in the pelvis.

Prevention

If you have had DVT or have risk factors, you can help prevent DVT by the following:

Avoid sitting for long periods of time.
When traveling, move your feet and legs often.
Go for short walks if possible.
Avoid crossing your legs and ankles when you sit.
Get regular exercise, according to your doctor’s advice.
Maintain a healthy body weight
Ask your doctor about special stockings you can wear to prevent clots and make sure you wear them correctly.
Keep your legs elevated when you are in bed or sitting down.
Leg exercises are important to prevent blood from pooling in the legs.
Walking as soon as possible after surgery will help lower your risk.
If you are unable to exercise, ask your doctor if someone should massage your lower legs through some range of motion exercises.
If you are currently being treated for DVT, do not massage your legs as the clot may break loose.
Stop smoking. Smoking increases the risk of blood clots.

Treatment

The goals are to prevent clots from forming and/or to prevent complications of the clot such as a stroke. Treatment also allows time for the clot to dissolve and helps to prevent new clots.

Blood thinners – are used to treat Deep Vein Thrombosis. These medicines are prescribed very carefully because they can cause internal bleeding. Examples are Heparin, Coumadin and Lovenox. Treatment requires balance of the risks of internal bleeding and the risk of clots. You will have blood tests to check the effects of the medicine on your blood clotting.
Your doctor may prescribe bed rest. This may seem odd but bed rest may reduce the risk of a piece of the clot breaking off and causing problems.
Treatment may start in the hospital. When your blood test is at a safe level you may go home and keep taking a blood thinner. You may learn to inject yourself with the medication or be switched to Coumadin to take by mouth.
You will have your blood checked often to make sure your blood clotting ability is in the safe range.
You may need to take a blood thinner for many weeks, maybe even for 6 months after your clot has been diagnosed. You may have a condition that keeps you at high risk for clots. In this case you may need to take a blood thinner for the rest of your life.

Take care of yourself

If you take anticoagulants (blood thinners):

Be sure to take the right amount of medicine at the right time each day
You will need blood tests on a regular basis to check how fast your blood clots. Follow your doctor’s schedule for these tests.
Wear a medic alert bracelet listing the drugs you take.
Before taking any new medicines, even nonprescription drugs, contact your doctor. Most medicines and antibiotics can interfere with or increase the effects of the anticoagulants.
Tell your health care providers, such as dentists and podiatrists that you are taking anticoagulants.
Do not take aspirin unless specifically prescribed by your doctor.

Call your Doctor right away if you have any of these symptoms:

Faintness
Dizziness
Severe headaches
Severe stomach pain
Increased weakness
Red or brown urine
Bruises that increase in size without further injury
Red or black bowel movements
Cuts that do not stop bleeding
Coughing up blood
Unexpected bleeding from any part of your body

Complications

It is uncommon for DVT to cause further problems but potential complications include the following:

Pulmonary embolism happens when a piece of the blood clot breaks off and travels in the blood stream to become lodged in the lungs and blocks blood flow. This can happen hours or even days after the formation of a clot in the calf veins. It may cause chest pains and shortness of breath. You should seek emergency medical treatment as a pulmonary embolism can be fatal in severe cases.
Post thrombotic syndrome happens if a DVT damages the valves in the vein, so that instead of flowing upwards, the blood pools in the lower leg. This can result in pain, swelling and ulcers on the leg.

Sources:
Medline Plus, A service of the U.S. National Library and the National Institute of Health. Adult Health Advisor, http://www.med.umich.edu/1libr/aha/aha_dvthromb_crs.htm

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