What are the warning signs of a blood clot in the inner thigh. How can you distinguish between a blood clot and a pulled muscle. What are the risk factors for developing deep vein thrombosis. When should you seek immediate medical attention for a suspected blood clot.

Understanding Deep Vein Thrombosis (DVT)

Deep vein thrombosis (DVT) is a serious medical condition characterized by the formation of a blood clot in a deep vein, typically in the leg. These clots can obstruct blood flow, leading to uncomfortable symptoms and potentially life-threatening complications if left untreated. DVT commonly occurs in the inner thigh region, making it crucial to recognize the signs and symptoms early on.

DVT can develop for various reasons, including prolonged periods of immobility, certain medical conditions, and genetic factors. It’s essential to understand that while DVT is more common in older adults, it can affect people of all ages, including children in specific circumstances.

What causes blood clots to form in the inner thigh?

Blood clots in the inner thigh can form due to several factors:

• Extended periods of inactivity, such as during long flights or hospital stays
• Injury to the blood vessel wall
• Increased blood coagulation due to certain medical conditions
• Hormonal changes, particularly in women taking birth control pills or hormone replacement therapy
• Obesity
• Smoking
• Genetic predisposition to blood clotting disorders

Understanding these risk factors can help individuals take preventive measures and seek timely medical attention when necessary.

Recognizing Blood Clot Symptoms in the Inner Thigh

Identifying the symptoms of a blood clot in the inner thigh is crucial for early detection and treatment. While some individuals may not experience noticeable symptoms, others may encounter a range of discomforts that should not be ignored.

What are the common symptoms of a blood clot in the inner thigh?

Common symptoms of a blood clot in the inner thigh include:

• Leg pain or discomfort that may feel like a pulled muscle
• Swelling in the affected leg
• Redness or discoloration of the sore spot
• Warmth in the affected area
• A throbbing sensation in the leg
• Tightness or cramping in the thigh

It’s important to note that these symptoms can vary in intensity and may not always be present in every case of DVT. If you experience any combination of these symptoms, especially without an apparent cause such as recent injury or overexertion, it’s advisable to seek medical attention promptly.

How can you distinguish between a blood clot and a pulled muscle?

Distinguishing between a blood clot and a pulled muscle can be challenging, as the symptoms may appear similar. However, there are some key differences to consider:

1. Onset of pain: A pulled muscle typically causes immediate pain after an injury or overexertion, while blood clot pain often develops gradually.
2. Swelling: Blood clots usually cause more significant and localized swelling compared to muscle strains.
3. Skin color changes: Redness or discoloration is more common with blood clots than with pulled muscles.
4. Warmth: The affected area may feel warmer to the touch in cases of blood clots.
5. Pain characteristics: Blood clot pain tends to be more constant and may worsen over time, while muscle pain often improves with rest and ice.

If you’re unsure about the cause of your symptoms, it’s best to consult a healthcare professional for an accurate diagnosis.

Risk Factors for Developing Deep Vein Thrombosis

Understanding the risk factors associated with DVT can help individuals take preventive measures and seek timely medical attention when necessary. While anyone can develop a blood clot, certain factors increase the likelihood of their occurrence.

Who is at higher risk for developing blood clots in the inner thigh?

Several groups of people are at an increased risk of developing blood clots in the inner thigh:

• Individuals over 60 years of age
• Those with a personal or family history of blood clots
• People who smoke
• Individuals who are overweight or obese
• Women taking birth control pills or hormone replacement therapy
• People who have recently undergone surgery
• Individuals confined to bed rest or sitting for extended periods
• Those with certain medical conditions, such as cancer or heart disease
• Pregnant women and those who have recently given birth

It’s important to note that having one or more risk factors doesn’t necessarily mean you will develop a blood clot. However, being aware of these factors can help you take appropriate precautions and discuss any concerns with your healthcare provider.

Blood Clots in Children: A Lesser-Known Risk

While blood clots are more commonly associated with adults, it’s crucial to recognize that children can also develop DVT under certain circumstances. Understanding the risk factors and symptoms in pediatric cases can help parents and caregivers remain vigilant.

What are the risk factors for blood clots in children?

Blood clots in children are rare but can occur due to various factors:

• Recent surgery or hospitalization
• Presence of a catheter or PICC line in a vein
• Extended periods of immobility
• Family history of blood clotting disorders
• Certain medical conditions, such as cancer or heart disease
• Use of birth control pills in teenage girls
• Obesity
• Dehydration

Parents and healthcare providers should be aware of these risk factors, especially in hospitalized children or those with chronic medical conditions. Early recognition and intervention can prevent potential complications associated with pediatric DVT.

When to Seek Medical Attention for a Suspected Blood Clot

Knowing when to seek medical attention for a suspected blood clot is crucial in preventing potentially life-threatening complications. While not all cases of DVT lead to serious issues, prompt evaluation and treatment can significantly improve outcomes.

When should you see a doctor for a possible blood clot in the inner thigh?

It’s advisable to seek medical attention if you experience any of the following:

• Unexplained leg pain or discomfort, especially if accompanied by swelling or redness
• Sudden onset of leg swelling without an apparent cause
• Warmth or tenderness in the affected area
• Visible changes in skin color, such as redness or discoloration
• Worsening of symptoms over time
• Any combination of DVT symptoms, particularly if you have known risk factors

If you suspect a blood clot, it’s best to err on the side of caution and consult a healthcare professional. Prompt evaluation can lead to early diagnosis and treatment, potentially preventing complications such as pulmonary embolism.

What are the signs of a pulmonary embolism that require immediate emergency care?

A pulmonary embolism is a serious complication that occurs when a blood clot travels to the lungs. Symptoms requiring immediate emergency care include:

• Sudden shortness of breath or difficulty breathing
• Chest pain that worsens with deep breaths
• Rapid heartbeat or palpitations
• Coughing up blood
• Dizziness or fainting
• Anxiety or a sense of impending doom

If you or someone around you experiences these symptoms, call emergency services immediately. Pulmonary embolism is a life-threatening condition that requires urgent medical intervention.

Treatment Options for Blood Clots in the Inner Thigh

Once diagnosed, blood clots in the inner thigh can be effectively treated with various medical interventions. The choice of treatment depends on the severity of the clot, the patient’s overall health, and other individual factors.

What are the common treatment methods for deep vein thrombosis?

Treatment options for DVT may include:

1. Anticoagulant medications (blood thinners): These drugs help prevent the clot from growing and reduce the risk of new clots forming.
2. Thrombolytic therapy: In severe cases, medications to dissolve the clot may be administered.
3. Compression stockings: These help improve blood flow and reduce swelling in the affected leg.
4. Lifestyle modifications: Including increased physical activity and maintaining a healthy weight.
5. Inferior vena cava (IVC) filter: In cases where blood thinners are not suitable, a filter may be placed in a large vein to prevent clots from traveling to the lungs.
6. Surgery: In rare cases, surgical intervention may be necessary to remove the clot.

The duration and specifics of treatment will vary based on individual circumstances and should be determined by a healthcare professional.

Preventing Blood Clots: Lifestyle Changes and Precautions

While not all blood clots can be prevented, adopting certain lifestyle changes and taking precautions can significantly reduce the risk of developing DVT, especially for those with known risk factors.

How can you lower your risk of developing blood clots in the inner thigh?

To reduce your risk of developing blood clots, consider the following preventive measures:

• Stay active: Regular physical activity improves blood circulation.
• Maintain a healthy weight: Obesity is a significant risk factor for DVT.
• Stay hydrated: Proper hydration helps maintain blood viscosity.
• Avoid prolonged periods of sitting: Take breaks to walk and stretch during long trips or workdays.
• Quit smoking: Smoking increases the risk of blood clots and other cardiovascular issues.
• Manage underlying health conditions: Properly control conditions like diabetes and high blood pressure.
• Wear loose-fitting clothing: Tight clothes, especially around the waist and legs, can impede blood flow.
• Consider compression stockings: These can be particularly helpful during long flights or periods of immobility.
• Discuss medication risks: If you’re taking hormonal medications, talk to your doctor about potential blood clot risks.

By incorporating these practices into your daily life, you can significantly reduce your risk of developing blood clots in the inner thigh and other parts of the body.

What precautions should be taken during long periods of inactivity, such as air travel?

During extended periods of inactivity, such as long-distance air travel, consider these precautions:

1. Move regularly: Walk up and down the aisle when it’s safe to do so.
2. Perform seated exercises: Flex and extend your ankles, rotate your feet, and stretch your legs periodically.
3. Stay hydrated: Drink plenty of water and avoid excessive alcohol consumption.
4. Wear loose, comfortable clothing: This helps promote better circulation.
5. Consider compression stockings: These can help improve blood flow in your legs during long flights.
6. Avoid sleeping pills: These can lead to prolonged immobility.
7. Choose an aisle seat when possible: This makes it easier to get up and move around.

By taking these precautions, you can reduce the risk of developing blood clots during periods of prolonged inactivity, whether during travel or in other situations that limit movement.

Understanding the symptoms, risk factors, and preventive measures associated with blood clots in the inner thigh is crucial for maintaining vascular health. By staying informed and proactive, individuals can significantly reduce their risk of developing deep vein thrombosis and its potential complications. Remember, if you suspect a blood clot, seeking prompt medical attention is always the safest course of action.

What Do Blood Clots in the Leg Feel Like?

Have you ever sat on a long flight, then stood up to leave the plane and noticed that your leg hurt in a way that it hadn’t at the start of your journey? Prolonged sitting may increase the risk of developing a blood clot in the leg, which is also called deep vein thrombosis (DVT).

DVT typically forms deep within a vein in the leg. When a blood clot forms, it can obstruct blood flow, leading to uncomfortable symptoms. If a clot breaks free from the spot where it formed, it may cause a potentially life-threatening condition known as pulmonary embolism, when the clot travels through blood vessels and enters the lung.

Not all blood clots in the leg lead to pulmonary embolism; some resolve on their own. But if you notice signs that you may have DVT, seeing a doctor quickly may help you avoid dangerous complications.

“There are effective treatments for a blood clot in the leg, most notably blood thinners, which hinder clotting ability while they’re being used,” says Vikalp Jain, M. D., vascular surgeon at Jersey Shore University Medical Center. “Seeking medical help early when you think that you may have a blood clot is always the right decision, even if it turns out to be nothing. It’s better to be safe than sorry when pulmonary embolism could be a possibility.”

Signs that you may have a blood clot

Many people who have a blood clot notice discomfort in the affected leg and can’t attribute the problem to a recent injury, overuse or another factor. They’re more common after surgery and among people on bed rest or those who sit for long periods without stretching.

Symptoms include:

• leg pain or discomfort that may feel like a pulled muscle, tightness, cramping or soreness
• swelling in the affected leg
• redness or discoloration of the sore spot
• the affected area feeling warm to the touch
• a throbbing sensation in the affected leg

Some people don’t experience noticeable symptoms, which makes it difficult for them to recognize that they should seek care.

Blood clots are more common among people who:

• smoke
• are obese
• take birth control pills or hormone replacement therapy
• have a personal or family history of blood clots

Can kids get blood clots in the leg?

“Blood clots are more common among people age 60 and older, but it’s possible for kids to experience DVT. They’re rare in healthy children, but they’re more common among kids who are hospitalized,” says Katherine Armstrong, M.D., MS, pediatric hematologist-oncologist of Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center.

Factors that may increase the risk of blood clots in children include:

• having had surgery
• having a catheter or PICC line placed in a vein
• being confined to bed
• having a family history of blood clots
• taking birth control pills (teenage girls)

When to seek care for a possible blood clot

If you think that you or your child may have a blood clot in the leg, seeing a doctor that day may help you avoid complications. If you can’t get a same-day appointment with your regular doctor, visit an urgent care center or emergency room. Quick care may help you ward off a pulmonary embolism, which may be deadly.

Whether or not you’ve noticed symptoms of DVT, seek emergency care if you have symptoms of a pulmonary embolism, including:

• sudden difficulty breathing or shortness of breath
• chest pain that worsens when you try breathing deeply
• a sudden cough, especially if you produce bloody mucus
• a fast heartbeat
• dizziness or losing consciousness

Healthy habits may lower your risk of blood clots

If you have a family history of blood clots or you’re about to have surgery, talk to your doctor about ways to lower your risk of DVT.

To lower your risk of blood clots in everyday situations, make lifestyle changes, including:

• breaking up long periods of sitting (whether at home, at work or while traveling)
• being more physically active
• maintaining a healthy weight
• quitting smoking

Next Steps & Resources:

• Meet our sources: Vikalp Jain, M. D., Katherine Armstrong, M.D., MS
• To make an appointment, call 800-822-8905 or visit our website.
• Find an urgent care center near you.

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

Top Warning Signs of Deep Vein Thrombosis

• 5 April 2019
• Dr. Obinna Nwobi

Deep vein thrombosis (DVT) is a condition that’s serious and life-threatening. How serious? Statistics say that 10-30% will die within one month of their diagnosis. However, that’s because many don’t know the warning signs, so they fail to get medical treatment before the condition turns serious.

The good news is that DVT can be successfully treated and stabilized when it’s diagnosed as early as possible. That’s why our team at Vein Health Clinics wants to let you know how to recognize the top warning signs of deep vein thrombosis.

Table of Contents

Why deep vein thrombosis is dangerous

Thrombosis is a medical term that refers to a blood clot. When you have deep vein thrombosis (DVT), you develop a blood clot in a vein that’s deep below the surface. While DVT may affect your arms or pelvis, it most often occurs in the lower leg.

DVT becomes a serious health threat when a piece of the blood clot breaks loose, travels through the bloodstream to your lungs, and blocks blood flow in one of the pulmonary arteries. This condition called a pulmonary embolism can be life-threatening.

Factors that increase your risk for deep vein thrombosis

DVT can develop when blood flow slows down in the vein or the blood vessel wall is damaged by an injury, inflammation, or surgery. Blood clots are also more likely to form when your blood is thicker or more likely to clot due to an imbalance in the biochemicals that control clotting.

Here’s a look at some of the factors that increase your risk for DVT:

• Immobility
• Injury or surgery
• Pregnancy
• Smoking
• Stroke
• Heart disease
• High blood pressure
• Being overweight or obese
• Inherited blood-clotting disorder

One of the primary risk factors for DVT is immobility. You may become immobile due to a long ride in a car or airplane, or when you spend an extended time in bed, whether due to an illness, injury, or surgery.

As leg muscles contract while you walk, the pressure pushes blood up through your veins. If you sit still too long — even if you’re just sitting in front of the TV or working at your computer — your blood doesn’t circulate properly, and your risk for blood clots increases.

Top warning signs of deep vein thrombosis

You may not experience any symptoms at first, but when they appear, you’ll develop these warning signs:

Swelling

About 70% of all patients develop swelling, which is the top warning sign of DVT. If your DVT is in your thigh or calf, you’ll only have swelling in the affected leg. However, if the blood clot is in your pelvis, you can develop swelling in both legs. In some cases, chronic pelvic pain may also be a symptom of a condition known as pelvic congestion syndrome. If you experience chronic pelvic pain that doesn’t improve with treatment, it may be worth considering this possibility.

Leg pain

Leg pain is the second most common sign, as it appears in 50% of all patients. Your pain may be mild or severe, but the extent of the pain isn’t associated with the size of the blood clot. The pain caused by a DVT, which may feel more like a cramp or tender area, is usually felt in the calf muscles or along the vein as it travels down your inner thigh.

Changes in your skin

Your skin may appear red or discolored. Additionally, the area of your leg that’s swollen or painful may also feel warmer than the rest of your skin.

Pain when your foot is flexed

Some patients feel pain when they flex their foot, moving the foot so the toes point up toward the knee.

Warning signs of pulmonary embolism

In about 25% of people with a DVT, the first symptom is sudden death due to a pulmonary embolism. For this reason, it’s vital to recognize the warning signs of pulmonary embolism, which are:

• Sudden shortness of breath
• Sudden chest pain that worsens when you take a breath
• Feeling lightheaded or dizzy
• Rapid pulse
• Coughing up blood

At the first sign of a pulmonary embolism, call 9-1-1 so that you can get emergency medical attention.

Even if your warning signs of deep vein thrombosis are mild, call Vein Health Clinics right away so we can determine whether you have DVT and start life-saving treatment. Our Florida offices are in Oviedo, Apopka, and Winter Haven, so contact the one most convenient for you.

Frequently Asked Questions

How Long Can You Have DVT Without Knowing?

You can have DVT (deep vein thrombosis) without knowing for several days or weeks. However, some people may experience swelling, pain, or warmth in the affected area. It is essential to seek medical attention if you suspect DVT to prevent potential complications.

Does DVT Pain Go Away When Sitting?

No, DVT pain may not go away completely when sitting. Sitting for long periods can worsen DVT symptoms, leading to decreased blood flow and increased pressure in the affected area. It is important to keep moving and avoid prolonged sitting or immobility if you have DVT.

What Does DVT Feel Like?

DVT (deep vein thrombosis) can feel different for each person, but common symptoms include swelling, pain, tenderness, warmth, and redness in the affected area. Some people may also experience a feeling of heaviness or achiness in the affected limb.

How Painful Is DVT?

DVT can range from mild to severe pain, depending on the individual and the extent of the clot. Others may experience severe pain and swelling, while others may only feel a dull ache. It is important to seek medical attention if you suspect DVT to prevent potential complications.

What Does Deep Vein Thrombosis Feel Like?

Deep vein thrombosis (DVT) can cause swelling, pain, tenderness, warmth, or redness in the affected area. Some people may also experience a feeling of heaviness or achiness in the affected limb. However, some people may not experience any symptoms, making DVT a potentially silent and dangerous condition.

What Is DVT In Medical Terms?

DVT (deep vein thrombosis) is a medical condition in which a blood clot forms in a deep vein, typically in the legs. This can lead to symptoms such as pain, swelling, and redness, and can potentially lead to life-threatening complications such as pulmonary embolism. Treatment typically involves blood thinners.

What Are The Warning Signs Of Deep Vein Thrombosis?

Warning signs of deep vein thrombosis (DVT) can include swelling, pain, tenderness, warmth, or redness in the affected area, as well as a feeling of heaviness or achiness in the affected limb. However, some people may not experience any symptoms, making DVT a potentially silent and dangerous condition.

Does DVT Pain Come And Go?

The pain associated with deep vein thrombosis (DVT) can come and go, depending on factors such as activity level and medication use. However, it is important to note that DVT pain can also persist and worsen over time, and may require medical intervention.

Can Inner Thigh Pain Be A Blood Clot?

Yes, inner thigh pain can be a symptom of a blood clot, particularly if the pain is accompanied by swelling, warmth, or redness in the affected area. This can indicate the presence of deep vein thrombosis (DVT), a potentially serious condition that requires medical attention.

Is DVT Pain Constant?

The pain associated with deep vein thrombosis (DVT) can vary from person to person, and may not always be constant. The pain may come and go, or it may persist and worsen over time. However, other symptoms such as swelling, warmth, and redness in the affected area may be present.

About The Author

Dr. Obinna Nwobi

Dr. Obinna Nwobi is a board certified vascular surgeon, who chose to practice in an underserved area in Florida. In a field that graduates only 100 new vascular surgeons a year, Dr. Nwobi is an exemplary vascular surgeon who worked for the Indian Health Services, Veterans Affairs Hospital, and large private and public hospitals.

Named 6 signs by which a bruise can be distinguished from a blood clot

• Health

Under a harmless bruise on the leg, arm or abdomen, a formidable disease can be hidden. The main thing is to notice the signs of the problem in time and start treatment.

April 21, 2022

Source:

Getty Images

Thrombosis is one of those dangerous diseases that may not make themselves felt at all for a long time – but if they are not diagnosed in time, it can lead to death. However, as doctors say, in some cases, the formation of a blood clot can be seen by external signs.

The problem is that this symptom is often confused with a bruise. However, there are several important differences between these phenomena.

Factors that increase the risk of experiencing thrombosis:

• Taking oral contraceptives;

• Past COVID-19;

• Obesity;

• Diabetes mellitus;

• Diseases of the heart and blood vessels;

• Genetic predisposition.

See also

According to experts, the symptoms of a blood clot may become noticeable if the blood clot is close to the surface of the skin or if it interferes with blood flow. This most often happens when a blood clot appears in the legs, arms, or abdomen. And in people with pulmonary embolism, the skin tends to take on a bluish tint.

If a blood clot has clogged the veins, spots may appear on the skin that resemble hematomas, as excess blood enters the tissues.

These manifestations of a blood clot can be easily confused with a bruise, but hematomas have several distinguishing features:

• In the bruised area, the skin usually changes color as it heals;

• Bruises are usually painful to the touch, and the more time has passed since the bruise appeared, the less discomfort it causes;

• Bruising usually occurs after an injury.

In addition, there are several symptoms that indicate that the cause of the spot on the skin is a blood clot and that you need to seek professional help as soon as possible:

• Throbbing or cramping pain in limbs, severe swelling or redness;

• Sudden shortness of breath, sharp pain in the chest, aggravated by inspiration;

• Cough, hemoptysis.

Other symptoms of a blood clot:

• Feeling tired, easily fatigued;

• Pale skin;

• Blue lips;

• Coldness in extremities;

• Disorders of brain activity.

Read also

In what cases is a bruise dangerous? For example, sometimes hematomas are confused with symptoms of varicose veins. If your bruise consists of small vessels, they look like stars or spiders, do not put off a visit to the specialists.

By the way, bruises often appear on the background of taking anticoagulant therapy: it would seem that you don’t hit so hard – but a hematoma appears. This is normal: such drugs increase bleeding time due to blood thinning.

Read also

By the way

Proper nutrition is one of the most important components of a healthy lifestyle. There are healthy foods, and there are eating habits that, for example, can increase the risk of a blood clot. You can read more about it HERE.

Text author: Daria Gapionok

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Postpartum thrombophlebitis. What is postpartum thrombophlebitis?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Postpartum thrombophlebitis is an obstetric complication characterized by inflammation of the walls of the veins, thrombosis in the pelvis and lower extremities, which develops in women after childbirth. The disease is manifested by fever, tachycardia, local pain. The diagnosis is made on the basis of anamnestic data, the results of a clinical examination, an ultrasound examination of blood vessels with duplex scanning, and a coagulogram. The main method of treatment is anticoagulant therapy, with a high risk of arterial thromboembolism, surgical intervention is indicated.

ICD-10

O87.0 Superficial thrombophlebitis in the puerperium

• Causes
• Pathogenesis
• Classification
• Symptoms of postpartum thrombophlebitis
• Complications
• Diagnostics
• Treatment of postpartum thrombophlebitis
  • Conservative therapy
  • Surgical treatment
• Prognosis and prevention
• Treatment prices

General

Postpartum thrombophlebitis is an acute disease of the veins in puerperas with the formation of blood clots in the lumen, an inflammatory process, and impaired venous blood flow. The incidence of venous thrombosis with associated or primary phlebitis in the postpartum period is 3.5%, almost an order of magnitude higher than the prevalence of thrombotic complications during pregnancy. Pathology can develop in puerperas of any age, but is more often recorded in women older than 35 years. When a vein is obstructed by a thrombus, in contrast to arterial thromboembolism, ischemia is detected extremely rarely, however, thrombosis of the inferior vena cava system is the main source of pulmonary embolism.

Postpartum thrombophlebitis

Causes

Postpartum thrombophlebitis has a multifactorial nature. A favorable background for the occurrence of pathology are physiological changes in the body of a pregnant woman: compression of the vena cava by the pregnant uterus, slowing down of the peripheral blood flow and an increase in the potential for blood clotting, most pronounced by the end of pregnancy. Significant risk factors for thrombotic complications after childbirth:

• Complicated childbirth. Childbirth, accompanied by ruptures of soft tissues (especially with massive bleeding), delivery by surgery often lead to thrombophlebitis of the deep veins of the thigh and lower leg. With extensive injuries, tissue thromboplastin enters the bloodstream, exacerbating the activation of blood coagulation characteristic of late pregnancy.
• Pathological course of pregnancy. The likelihood of developing postpartum thrombotic complications significantly increases gestosis. This pathology is accompanied by vascular spasm with damage to the endothelium, the release of biologically active substances, leading to the loss of thromboresistant properties of blood vessels.
• Inflammation of the uterus. Postpartum metroendometritis triggers thrombosis in the uterine, pelvic and ovarian veins. The mechanism of development of thrombosis is similar to that in preeclampsia: the result of alteration is the release of prostaglandins, which are transformed into thromboxane A2, which stimulates the activation and aggregation of platelets.
• Extragenital pathologies. Venous thrombosis affects puerperas suffering from diseases accompanied by circulatory disorders – cardiac pathologies (especially of a rheumatic nature), hypertension. The main risk factors also include vasculitis of any etiology, malignant neoplasia.
• Taking hormonal drugs. To aggravate the hemostatic changes associated with pregnancy, long-term use of hormonal contraception (especially with a high content of estrogen) can. The likelihood of thrombosis is increased in puerperas who become pregnant after hormonal induction of ovulation (with or without IVF).
• Hemostasis defects. Postpartum thrombophlebitis often develops in women with a congenital mutation of factor V Leiden and the prothrombin gene, congenital hyperhomocysteinemia, deficiency of antithrombin III and proteins C, S, or acquired thrombophilia (antiphospholipid syndrome, hyperhomocysteinemia on the background of a deficiency of vitamins B12, B9, B6, B1).

Other risk factors include physical inactivity (when standing or sitting, long flights, long bed rest), heavy physical activity (overweight, regular weight lifting), late reproductive age. Increase the risk of thrombosis intravenous infusion, smoking. One of the main predisposing conditions for the development of complications not associated with gestation is nonspecific connective tissue dysplasia, the signs of which include varicose veins of the lower extremities, hemorrhoids that arose before pregnancy.

Pathogenesis

The mechanism of thrombus formation is based on the so-called Virchow triad, which includes changes in hemostasis (increased blood clotting) and hemodynamics (reduced venous blood flow), damage to the venous wall. Thrombogenesis can occur against the background of hypercoagulation (phlebothrombosis) with the subsequent development of reactive inflammation, or vice versa, a thrombus occurs due to damage and then inflammation of the endothelium. The blood clot is fixed to the vascular wall at the site of its lesion, its further evolution follows one of three paths.

The first way is characterized by the growth of a thrombus, the second – by its spontaneous lysis, the third – by the organization of thrombotic masses (their germination by connective tissue and capillaries). The process is accompanied by the formation of cavities in the clot, spontaneous recanalization of the thrombus due to fibrinolysis. In small vessels, occlusive thrombi are more often formed, completely blocking the lumen, in large vessels – floating, bathed in blood. The latter are embologenic – with a high probability of detachment, movement through the inferior vena cava and the right atrium into the arterial circulation.

Classification

Postpartum thrombophlebitis are superficial, extending to the saphenous veins of the lower extremities, and deep, with damage to the large main vessels of the legs and pelvis. According to the nature of inflammation, purulent and non-purulent forms are distinguished, according to the type of thrombus development – limited or segmental, with rapid delimitation, organization of a blood clot and progressive – with its further growth. According to localization, the following classification of the pathology that developed after childbirth was adopted:

• Thrombophlebitis of the leg veins. Superficial thrombophlebitis is manifested by lesions of the small, large saphenous veins of the leg and their tributaries, deep – tibial veins. Pathological changes in deep vessels can occur in isolation or spread from superficial vessels through communicants. With ascending thrombophlebitis, the femoral vein is involved in the process.
• Ileofemoral (ileofemoral) thrombophlebitis. Starting with physiological thrombosis of the vessels of the placental site, it spreads to small tributaries of the internal iliac vein, then to its trunk and further to the common iliac vein. With occlusion of the latter, the deep and superficial vessels of the thigh are involved in the pathological process.
• Pelvic thrombophlebitis. The venous plexus of the small pelvis – uterovaginal, cystic, rectal, pampiniform plexus of the ovary – undergoes the process of inflammation and thrombosis. With progression, the iliac vein is affected, and then the femoral vein.
• Metrothrombophlebitis. The defeat of the main uterine veins, originating from the uterine venous plexus. Thrombophlebitis of the veins of the uterus is almost always the result of postpartum endometritis.
• Thrombophlebitis of the ovarian vein. Pathology is characterized by changes in the cavity of the main vessel that collects blood from the venous plexus of the ovary. An extremely rare disease that develops almost exclusively after childbirth, most often against the background of congenital or acquired thrombophilia.

Symptoms of postpartum thrombophlebitis

Signs of a pathological condition can be detected as early as the fifth or sixth day after childbirth, but more often the manifestation is noted in the second or third week after delivery. Harbingers of the disease are long-term subfebrile temperature, increasing heart rate. The beginning is marked by a brief chill. Symptoms may vary depending on the location of the lesion.

Superficial thrombophlebitis is accompanied by the most striking manifestations: tension, soreness, redness along the affected vessels, local and general fever. With thrombophlebitis of the deep veins of the lower leg, swelling of the ankles is observed (usually pronounced in the evenings, subsiding after a night’s sleep), pain in the calves while standing up and walking, as well as with dorsiflexion of the foot (Homans symptom).

Pelvic vein thrombosis has no specific symptoms until the transition to the iliac and femoral vessels with the development of edema of the inguinal region on the affected side. Prior to this, only prolonged subfebrile condition with tachycardia is detected, pain during defecation, flatulence, and sometimes vomiting can be observed. Often, patients complain of dyspareunia, general weakness, vague pelvic and lumbar pain.

Ileofemoral thrombophlebitis proceeds for a long time with uncertain symptoms – fever, tachycardia. Sometimes there are pains in the lower abdomen and sacral region, difficulty urinating. Complete occlusion of the iliac vein is accompanied by sudden pain in the iliac, inguinal regions, radiating to the thigh, chills, swelling of the anterior abdominal wall, lower back, and external genitalia. Pain is accompanied by a feeling of fullness of the thigh and calf.

When the deep femoral veins are involved, fever, rapidly developing persistent edema of the limb (the volume of the affected thigh is increased by 5-15 cm or more), acute unbearable pain in the anterior-internal region of the thigh along the vascular bundle are detected. Inguinal-femoral lymph nodes are enlarged. The skin of the affected limb is pale, has a bluish-marble hue, its foot is colder than healthy. The general condition is severe.

Metrothrombophlebitis, which develops in the second week of the postpartum period, is accompanied by pelvic pain, bloody discharge from the genital tract, which increases by the end of the third week. The defeat of the veins of the ovary has no pathognomonic symptoms. Spontaneous abdominal pains are recorded (usually right-sided, since 90% of women thrombosis affects the right ovary), radiating to the groin, pain when pressing on the ovary, fever.

Complications

The most formidable complication of venous thrombosis is pulmonary embolism (PE), detected in 40-50% of patients. In 10% of patients, the pulmonary trunk and large arterial branches are affected with the development of massive pulmonary embolism (usually due to thrombosis of the iliac-femoral or popliteal-femoral segment, less often – pelvic venous plexuses), leading to acute cardiopulmonary failure, death. When emboli blockage of smaller branches (the result of deep phlebothrombosis of the vessels of the lower leg), a heart attack-pneumonia is observed.

The consequence of widespread thrombosis is the occurrence of varicose veins, post-thrombophlebitic syndrome, leading to chronic venous insufficiency (CVI) and disability. The defeat of the ileofemoral segment with complete obstruction of the vascular collaterals is accompanied by arterial spasm, can provoke limb ischemia, venous gangrene. Complications of ovarian vein thrombophlebitis include ovarian infarction, acute ureteral obstruction, acute renal and multiple organ failure.

Diagnostics

Diagnosis of postpartum thrombophlebitis is usually difficult due to the lack of specific signs. The only exceptions are lesions of the superficial veins of the extremities with their vivid symptoms. The diagnosis is established with the participation of an obstetrician-gynecologist and a phlebologist. It is possible to suspect thrombotic complications by analyzing the anamnestic data, the patient’s complaints. Further activities include:

• Clinical examination. Thrombophlebitis may be indicated by severe tachycardia, combined with hyperthermia, sometimes not corresponding to body temperature values. During a gynecological examination and a general examination with thrombotic complications in puerperas, the affected vessels are palpated, represented by dense painful bands.
• Ultrasonic angioscanning. The most informative method for diagnosing thrombophlebitis in modern phlebology is ultrasound. The study allows you to determine the boundary and degree of organization of the thrombus, assess the condition of the valves, the walls of deep and perforating veins. If ultrasound is not available, ultrasound is performed.
• Coagulation studies. To clarify the causes of thrombophlebitis, two methods are used – thromboelastography and coagulometry. With the help of the first method, changes in the coagulological cascade are studied in an integrated way, with the help of the second, its individual chains are evaluated in detail. A comprehensive analysis allows you to determine which of the links of hemostasis is broken.

Differential diagnosis is carried out with other purulent-inflammatory diseases (appendicitis, parametritis, sepsis), pathologies of the urinary system (nephrotic syndrome, pyelonephritis, urolithiasis), diseases of the skin and soft tissues (erysipelas, cellulitis, phlegmon). Thrombophlebitis should also be distinguished from regional metastases of cancer of the external genitalia.

Treatment of postpartum thrombophlebitis

Conservative therapy

The main tasks of therapeutic measures are the prevention of the spread of thrombosis, the relief of inflammation, and the prevention of the recurrence of the disease. Superficial thrombophlebitis is usually treated on an outpatient basis with the patient as active as possible (excluding static loads). Therapy of thrombophlebitis of deep veins of the extremities and intrapelvic localization is carried out on the basis of a surgical hospital. With floating thrombi, strict bed rest is prescribed in order to reduce the likelihood of a blood clot detachment and the development of arterial thromboembolism.

• Anticoagulant treatment. Anticoagulants do not promote the resorption of a blood clot, but they stop the progression of thrombosis. After establishing the diagnosis, systemic therapy with low molecular weight heparins is first used, after which they switch to long-term use of indirect anticoagulants.
• Antibiotic therapy. Antibacterial drugs are prescribed according to strict indications – with thrombophlebitis that developed against the background of a purulent-inflammatory process. With reactive (aseptic) inflammation, antibiotic treatment is not only useless, but can also be harmful, because it increases blood clotting, leading to the progression of the disease.
• Anti-inflammatory treatment. For the treatment of aseptic phlebitis, non-steroidal anti-inflammatory drugs (ketoprofen, diclofenac) are used. These drugs help to relieve inflammation, eliminate pain, and have an antiplatelet effect. Used parenterally, orally and topically.
• Angioprotectors and microcirculation correctors. Agents such as rutoside and troxerutin reduce the permeability of the vascular wall, reducing the inflammatory response. Assigned inside, topical application is ineffective. Intravenous administration of pentoxifylline improves the rheological properties of blood.
• Compression therapy. Elastic compression of the lower extremities is indicated for extra-pelvic varicose veins. The bandage reduces venous stasis, which prevents further thrombosis. As a rule, bandaging is initially used, after the pain subsides, they switch to long-term wearing of compression stockings.

Surgical treatment

Surgical intervention is prescribed for contraindications to anticoagulant pharmacotherapy (danger of bleeding, idiosyncrasy to drugs), the presence of a floating thrombus and repeated episodes of PE, aimed at preventing thromboembolism from entering the arterial bed. Another indication for surgery is venous ischemia. Treatment is carried out by an endovascular surgeon and includes the following methods:

• Recanalization of a thrombosed vessel. Removal of thrombotic masses in order to restore the patency of the vein is performed by a mechanical (thrombectomy) or biochemical (regional selective thrombolysis) method. Since the introduction of thrombolytics can provoke the separation of the floating “tail” of the thrombus, the patient is pre-installed with a cava filter.
• Cava filter implantation. Fixation to the walls of the vena cava of a device that allows blood to pass through, but delays emboli in order to prevent pulmonary embolism. The method is limited in use in young patients planning further implementation of the reproductive function due to the lack of data on long-term effects. An alternative is vessel suture filtration.
• Vein suture. It consists in the imposition of U-shaped sutures that capture both venous walls. As a result, a filter is formed that does not allow emboli to pass through. With thrombophlebitis, plication of the inferior vena cava, femoral veins, and iliac vein is practiced. The technique is used when it is impossible to implant a cava filter.

Prognosis and prevention

The prognosis depends on the prevalence and localization of the thrombotic process, the possibility of eliminating etiological factors, the age of the patient and the activity of her immune system. Relapses are recorded in 10-30% of patients. Primary prevention includes the fight against gynecological inflammatory diseases, drug correction of hemostasis in women at risk. Other activities include giving an elevated position to the legs in bed, early activation of patients after delivery, wearing compression stockings.

You can share your medical history, what helped you in the treatment of postpartum thrombophlebitis.

Sources

1. Complications of postpartum thrombophlebitis and their prevention / Khadzhieva E.