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:

  • Leg pain with walking (muscle cramp or sharp pain) 
  • Sharp pain in the affected limb that starts in the calf 
  • Red or discolored skin on the affected limb 
  • Swelling in the affected limb 
  • Sudden onset leg swelling
  • 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 
Superficial Vein Thrombosis
A superficial vein thrombosis (SVT) is a blood clot in a superficial vein, not a deep vein. Because a superficial vein is closer to the surface of the skin, and not buried within the muscle like deep veins, you can usually feel an STP. An STP often feels like a hot, painful cord. The overlying skin can sometimes turn red. SVT do not tend to cause serious complications because they usually do not travel to the heart and lungs. However, it is important to have an ultrasound because 15% of the time in spontaneous STP, there is an associated deep vein thrombosis. Also, sometimes the STP can be located next to or at the junction of a deep vein. In this case, a blood thinner may be prescribed to prevent the superficial clot from extending into the deep vein. A blood thinner may also be prescribed if the STP is extensive and very painful. Otherwise, an STP is often managed with warm compressions, NSAIDS for pain and inflammation or aspirin

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, prevent the clot from breaking loose and traveling to the lungs 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. The most commonly used injectable blood thinners for DVT are enoxaparin (Lovenox) and fondaparinux (Arixtra). Oral medications such as Eliquis, Xarelto and Pradaxa are well tolerated and are more common than injections in the out-patient setting. Sometimes warfarin is used, but less commonly as it requires regular blood tests and monitoring

Oral medications can be started immediately after diagnosis. 

Pregnant women shouldn’t take certain blood-thinning medications like most oral blood thinners, but can usually take lovenox injections safely. Collaboration with you OB doctor is important to choose a medication safe for mom and baby.

You might need to take blood thinner pills for three months or longer. The time frame depends on the cause of the clot, the extent and severity and risk for another clot in the future. If an underlying blood clotting disorder is suspected, you may be referred to hematology for blood tests and long term recommendations.

 

• 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. 

OUR PATIENTS SAY

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