Deep Vein Thrombosis

When blood moves too slowly in your veins, it can cause a clump of blood cells (a blood clot or Thrombus). Deep vein thrombosis (DVT) is a condition in which a blood clot forms in the deep vein located in the leg, thigh, or pelvis. While Deep vein thrombosis (DVT) is common in the lower leg, it can also develop in other body parts, including the arms. So, how do blood clots form in the veins, and is it dangerous? 

To answer this, let us look at how the blood circulates in the body. The blood circulatory system consists of two blood vessels, namely the arteries and veins. The arteries carry blood rich in nutrients and oxygen from the heart, while the veins carry the deoxygenated blood back to the heart. Arteries have thin muscles within their walls that make them capable of withstanding the pumping pressure from the heart. However, the veins have no muscle lining and entirely depend on the muscle movement to take the blood back to the heart. 

How do Blood Clots Form?

The venous system in the legs consists of two main veins, the superficial veins, and deep veins. As the name suggests, deep veins are located deep within the muscles. On the other hand, superficial veins are located just below the skin and are easily visible. Typically, the blood flows from the superficial veins into the deep venous system through perforator veins. Both the perforator and superficial veins have valves that allow blood to flow in one direction. 

However, when blood travels slowly in the veins or pools in the veins, the platelets tend to stick together. While a blood clot (thrombus) in the deep venous system of your leg is not dangerous by itself, it can become life-threatening when it breaks and travels to enter the pulmonary vein. When the blood clot blocks a pulmonary artery, it decreases the amount of oxygen absorbed in the blood, causing a life-threatening condition known as pulmonary embolism. 

Deep vein thrombosis (DVT) is considered a medical emergency. According to the CDC (Center for Disease Control and Prevention), 10 – 30 percent of individuals who develop leg DVT experience life-threatening complications within a month of diagnosis. 

DVT SYMPTOMS

Like other disorders that affect the venous system, some individuals with DVT may not notice any symptoms. However, if the symptoms develop, people with deep vein thrombosis (DVT) may experience the following:

  • Sharp pain in the affected limb that starts in the calf 
  • Red or discolored skin on the affected limb 
  • Swelling in the affected limb 
  • Enlarged veins 
  • Increased warmth in the swollen, painful region 

Most often, deep vein thrombosis (DVT) affects only one leg, although, on rare occasions, the condition may develop in both legs. If the blood clot (thrombus) breaks and travels up to the lung, a person suffering from pulmonary embolism may have the following:

  • Sudden breathlessness or slow breathing 
  • Rapid breath 
  • Increased heart rate 
  • Chest pain that worsens when breathing deeply 

There are three main goals to DVT treatment. 

  • Prevent the clot from getting bigger. 
  • Prevent the clot from breaking loose and traveling to the lungs. 
  • Reduce your chances of another DVT. 

DVT treatment options include:

• Blood thinners. DVT is most commonly treated with anticoagulants, also called blood thinners. These drugs don’t break up existing blood clots, but they can prevent clots from getting bigger and reduce your risk of developing more clots. 

Blood thinners may be taken by mouth or given by IV or an injection under the skin. Heparin is typically given by IV. The most commonly used injectable blood thinners for DVT are enoxaparin (Lovenox) and fondaparinux (Arixtra). 

After taking an injectable blood thinner for a few days, your doctor may switch you to a pill. Examples of blood thinners that you swallow include warfarin (Jantoven) and dabigatran (Pradaxa). 

Certain blood thinners do not need to be given first with IV or injection. These drugs are rivaroxaban (Xarelto), apixaban (Eliquis) or edoxaban (Savaysa). They can be started immediately after diagnosis. 

You might need to take blood thinner pills for three months or longer. It’s important to take them exactly as prescribed to prevent serious side effects. 

If you take warfarin, you’ll need regular blood tests to check how long it takes your blood to clot. Pregnant women shouldn’t take certain blood-thinning medications. 

• Clot busters. Also called thrombolytics, these drugs might be prescribed if you have a more serious type of DVT or PE, or if other medications aren’t working. 

These drugs are given either by IV or through a tube (catheter) placed directly into the clot. Clot busters can cause serious bleeding, so they’re usually only used for people with severe blood clots. 

• Filters. If you can’t take medicines to thin your blood, you might have a filter inserted into a large vein — the vena cava — in your abdomen. A vena cava filter prevents clots that break loose from lodging in your lungs. 

• Compression stockings. These special knee socks reduce the chances that your blood will pool and clot. To help prevent swelling associated with deep vein thrombosis, wear them on your legs from your feet to about the level of your knees. You should wear these stockings during the day for at least two years, if possible. 

At La Jolla Vein & Vascular, we do not treat acute blood clots. We can diagnose them if your physician has referred you to our vascular lab, and your physician would use that information in determining how best to treat your clot as they know your health history best. Many blood clots can be treated in the out-patient setting with oral anticoagulant medication. More severe blood clots may require hospital admission for thrombolysis as described above and monitoring.  

We can help with longer term management of blood clots to reduce the risk of post-thrombotic syndrome and reduce the recurrence of blood clots in some individuals. Some patients may have a condition called May-Thurner syndrome, also known as iliac vein compression syndrome or Cockett’s syndrome, affects two blood vessels that go to your legs. It could make you more likely to have a DVT (deep vein thrombosis) in your left leg. We can treat May-Thurner if indicated using a stent or angioplasty. This is a common treatment for May-Thurner syndrome. First, your doctor uses a small balloon to expand the left iliac vein. Then, you get a device called a stent. It’s a tiny cylinder, made of metal mesh, that keeps the vein open wide so blood can flow normally.  

OUR PATIENTS SAY

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