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DEEP VEIN THROMBOSIS

What Is Deep Vein Thrombosis?

Deep vein thrombosis (DVT) is a blood clot that develops in a deep vein. Usually, these clumps of solid blood product develop in the lower extremities. However, DVT can occur in other areas of the body, as well.

Causes Of Venous Thrombosis

Clotting in a deep vein may occur for reasons such as:

  • A complication of surgery. There is always a risk of blood vessel damage during a surgical procedure. The bed rest that occurs after surgery also presents a risk of DVT due to the lack of movement. For this reason, many patients are encouraged to walk as soon as possible after surgery. When bed rest is a must, special compression devices may be placed on the legs to keep blood moving properly through the veins.
     

  • Sedentary lifestyle in which one sits frequently and for longer periods may encourage blood to pool in the legs. This can eventually lead to clot formation.
     

  • Injury to the leg or other area could cause narrowing in a blood vessel or damage to the vessel wall that leads to a blood clot.
     

  • Certain medications may also lead to a blood clot.

Deep Vein Thrombosis Symptoms

One of the concerns about DVT is that only about half of the people who develop a deep blood clot will also develop symptoms.

 

Indications that require prompt medical care include:

  • A chronic or recurrent cramp in one leg, usually at the calf.

  • Swelling in one foot, ankle, or leg.

  • Severe pain in the ankle or foot that cannot be explained.

  • Red or blue discoloration of the skin on one part of the leg.

  • An area of skin feels warm to the touch compared to surrounding areas.

How is DVT Diagnosed?

There are several tests that a doctor may perform if a patient shows signs of DVT. The first is to perform a duplex ultrasound on the area of study. Duplex ultrasound is a two-step process. First, B-mode ultrasound is performed to obtain an image of the area. B-mode stands for brightness modulation. Ultrasound works by emitting high-energy sound waves into the body. These sound waves bounce off internal structures, creating echoes that form an image. The images obtained during the ultrasound are immediately visible to the ultrasound technician, who uses the ultrasound “wand” to compress veins. DVT can keep a vein from collapsing beneath the compression, leading to an accurate diagnosis. The second part of the Duplex ultrasound involves Doppler ultrasound. In this part of the diagnostic process, sound waves directed at the area of study bounce off blood as it moves through the vein. This offers a real-time “Doppler effect” that can observe how the blood is circulating through the vein. The Duplex ultrasound is effective at identifying 95% of DVTs located above the knee. 

While Duplex ultrasound imaging is highly accurate and able to diagnose the majority of DVTs, there are additional tests that a doctor may recommend if the ultrasound comes back negative. In the event of a negative ultrasound but continued symptoms, the doctor may order an MRI to examine the veins more closely. A D-dimer test is another option that may be used to confirm or rule out the presence of a clot in difficult ultrasound cases. 

Can Healthy Athletic People Get DVT?

Yes. It is commonly believed that DVT occurs in older people, pregnant women, or people who have recently had surgery. However, recent studies show that athletes may have unique risk factors themselves. These include the time that an athlete, especially a professional athlete, may spend traveling to various events. Dehydration as a result of strenuous activity may also present a risk of DVT. Finally, athletes who have experienced traumatic injuries while playing sports may be at risk for DVT. Athletes are not different than the average person when it comes to inherent risks for DVT, such as family history and abnormal venous anatomy. If  you are a healthy, athletic person, you still need to know the signs of DVT so you can better protect your health.

What Precautions Should I Take on Plane Rides?

The Centers for Disease Control and Prevention recommend that people traveling more than four hours, regardless of the mode of transportation, take precautions to prevent DVT.

 

These include:

  • Refrain from sitting for more than two to three hours at a time. Get up at least that often to walk around. 

  • Exercise the legs and calf muscles when seated. You can do this by raising and lowering your heels while the toes are on the floor and then raising the toes while the heels are on the floor.

  • When there is a known risk for DVT, compression stockings may be worn when traveling. 

With DVT Do I Need to Worry About Blood Clots During Surgery?

It depends on how long ago the DVT occurred. Generally, patients who are interested in an elective surgical procedure are advised to wait several months before doing so. It is also necessary to inform the surgeon about the DVT, when it occurred, and other required details. The surgeon may advise waiting a longer period or may discuss techniques that can be used to minimize the risk of a subsequent DVT during or after surgery. For example, the surgeon may recommend anticoagulant medication or may apply compression stockings or intermittent pneumatic compression (IPC) during surgery. 

How Can You Prevent DVT During Pregnancy?

The risk of DVT during pregnancy is elevated due to the compression of the pelvis as the fetus grows. Beginning early in pregnancy and lasting until six weeks postpartum, the mother’s clotting factors in her blood are also varied. This may relate to changes in estrogen levels. Because these factors cannot be avoided during pregnancy, women should talk to their obstetricians about ways to mitigate their risks. General suggestions include maintaining a healthy, active lifestyle. Regular exercise throughout pregnancy can prevent excess weight gain and also support optimal blood flow. Women who are on bedrest during pregnancy may be prescribed anticoagulant blood-thinning medication to prevent DVT.

 

In addition to moving frequently throughout the day and avoiding becoming sedentary, pregnant women may be encouraged to wear compression stockings. To reduce the chances of the blood becoming too thick, women should also drink more water every day than they did prior to pregnancy. Until a woman stops breastfeeding, it is advantageous to drink about 12 glasses of water a day.  

Can You Develop DVT at Any Age?

DVT can develop at any age. This condition tends to be relatively rare in children and younger adults due to their normal level of physical activity. DVT is usually seen in adults over the age of 40, especially those who sit for long periods and who lack good muscle tone in the legs.

These same symptoms may occur in the neck, shoulder, arm, or hand if the blood clot has developed in the upper body.

Who Is At Risk For Developing DVT?

People over the age of 50 have the highest risk of DVT. However, this condition may occur at any age when contributing factors are present.

 

These include:

  • Family history of clotting disorders or DVT

  • Severe injury that has caused vein damage

  • Smoking

  • Taking hormonal birth control or therapy

  • Having a catheter in a vein

  • Being overweight

  • Sitting for a long period, especially repeatedly

  • Heart failure and certain other medical conditions may increase the risk of clots

What Are The Complications Of Deep Vein Thrombosis?

The primary risk of deep vein thrombosis is the movement of the clot from an extremity to the lung. This is referred to as pulmonary embolism. The clot dislodges from its arm or leg and becomes stuck in a smaller artery in the lung. The blockage that results can be life-threatening and requires emergency care.

Signs of pulmonary embolism include:

  • Rapid heart rate

  • Chest pain that worsens with deep inhales or coughing

  • Sweating

  • Dizziness

  • Rapid breathing

  • Coughing up blood

Preventing Venous Thrombosis

One of the best ways to reduce the risk of deep vein thrombosis is to move frequently. The contractions of the lower legs, especially, helps blood move upward with more efficiency. Additionally, patients are encouraged to maintain a healthy weight so undue pressure is not placed on the pelvis and lower extremities. Finally, maintaining healthy blood pressure and avoiding smoking are recommended lifestyle changes.

When taking long flights are other rides, it is beneficial to move around every hour or two if possible. When sitting, stretch the legs out and move the feet to contract the calves. When undergoing surgery, talk with the surgeon about taking a blood thinner before the procedure. Follow post-surgical guidelines provided by the surgeon, as well.

Deep Vein Thrombosis Treatment Options

If you suspect that you may have deep vein thrombosis, either go to the nearest emergency room or contact our doctor immediately. A thorough consultation and examination are needed to confirm the nature of your symptoms.

The purpose of DVT treatment is to prevent the clot from expanding and decrease the risk of pulmonary embolism or additional blood clot development.

 

Some of the methods used to do this include:

  • Medication to thin the blood. This encourages adequate blood flow to prevent clot formation. Blood thinners can also inhibit the enlargement of existing clots. In more severe cases or instances of an upper-body DVT, a thrombolytic drug may be prescribed to break up the clot.

  • Compression stockings may be used after surgery or in instances of poor circulation to prevent the swelling that may lead to blood clots.

  • A filter may be inserted into the vena cava, the large vein in the abdomen. This is a short-term technique that keeps clots from entering the lungs.

  • DVT surgery may be performed to remove a large clot or a clot that is causing tissue damage or other serious issues. The thrombectomy procedure locates and removes the clot from the blood vessel and then repairs the vessel and any tissue that has been damaged.

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