Can a DVT go away on its own?

Can DVT go away on its own?  

Being diagnosed with a blood clot can be a scary experience. While some blood clots are a normal part of your bodily function and will resolve on their own, others are more serious and can even become fatal if left untreated. If you’ve been diagnosed with a DVT (deep vein thrombosis), you may be wondering if your condition will resolve on its own or if medical intervention is necessary. Here’s what you should know before scheduling your consultation at the Vascular Institute of the Rockies.

What is DVT?
Deep vein thrombosis (DVT) takes place when a blood clot develops in at least one of the deep veins of your body, most commonly your legs. DVT can happen as a result of many factors, including having a medical condition that impacts the way your blood clots or when you don’t move your legs for an extended period of time, such as after having surgery or traveling a long distance. DVT can be very dangerous and should be taken seriously because it is possible for these blood clots to break free and travel through your blood to your lungs, resulting in a pulmonary embolism.

What Are the Symptoms of DVT?
It’s estimated that as many as 30% of people with DVT won’t exhibit any warning signs or symptoms. While this is true, others may experience these DVT symptoms:

•    Tenderness or pain in your arm or leg
•    Swelling in your arm or leg
•    Red or discolored skin
•    Veins that appear larger than usual
•    A swollen limb that is warm to the touch

Can a DVT Go Away on Its Own?
While it is possible for blood clots to be absorbed by your body and resolve on their own without any medical assistance, this is more common in blood clots that are small. If your healthcare provider suspects that you could have DVT, they will likely perform a series of tests to provide you with a diagnosis and personalized treatment plan. Testing for DVT could include:

•    Venous ultrasonography: This test is widely used to diagnose DVT because it is non-invasive and easily accessible. It uses ultrasound waves to display the blood flow and identify clots in your blood vessels.  
•    Venography: This test injects a special dye into a catheter that is inserted into your posterior knee or neck. This study/procedure can help determine whether blood flow is partially or completely blocked through your veins.
•    Magnetic Resonance Imaging (MRI): This method of imaging can be used in patients for whom ultrasound is infeasible.  It can provide an image of the veins in a specific area of your body to display the size and location of blood clots.

What Are the Treatment Options for DVT?
If you are diagnosed with a DVT, undergoing professional treatment can prevent the clot from getting bigger, prevent it from breaking away and traveling to your lungs, and prevent another DVT from occurring. Your healthcare provider is likely to recommend one or more of the following DVT treatment options:

•    Blood thinners to help the clot from getting bigger
•    Clot busters
•    Filters
•    Compression stockings

After your DVT treatment is complete, making certain lifestyle changes can reduce your chances of developing another DVT in the future. These include:

•    Taking your prescribed medications as directed
•    Wearing compression stockings
•    Talking to your doctor about what foods to eat or avoid
•    Avoiding sitting or standing for long periods of time

Promoting good circulation and strong veins is one of the most important steps you can take to live a long, healthy life. If you experience any of the symptoms of DVT, don’t wait to schedule an appointment with the experienced team at the Vascular Institute of the Rockies. We are eager to provide you with an accurate diagnosis, personalized treatment plan, and, most importantly, DVT prevention tips to keep your veins clot-free for years to come. Contact us today to schedule your appointment!

Deep vein thrombosis (DVT): Overview – InformedHealth.org

Created: March 23, 2017; Next update: 2020.

Introduction

Thrombosis is the medical term for the formation of a blood clot in a blood vessel. In deep vein thrombosis (DVT), the blood clot forms in one of the larger, deeper veins that run through the muscles. Deep vein thrombosis usually occurs in the lower leg.

It often goes unnoticed and dissolves on its own. But it may cause symptoms like pain and swelling. If someone is diagnosed with DVT, they will need treatment to avoid serious complications such as pulmonary embolism. This can occur if the blood clot breaks away from its original site and is carried to the lungs in the bloodstream.

The risk of deep vein thrombosis increases after more major operations such as knee or hip replacement surgery. Because of this, people who have had this kind of surgery are usually given medication to prevent blood clots from forming.

Symptoms

Typical symptoms of DVT include pain in a leg or hip, tenderness, tightness and red skin. The affected area may also swell and feel warm. But sometimes deep vein thrombosis doesn’t cause any symptoms.

Causes and risk factors

Blood clots may form if the blood flow in a vein is too slow, if there is a blood clotting disorder, or if the wall of a blood vessel is damaged. This can happen in the following cases:

• After longer periods of bed rest, for instance in hospital, after a bone fracture or injury. Staying in bed for a long time and not moving much can lead to poor blood circulation in your legs.

• Blood clotting disorders: Some people are born with a disease that makes their blood clot too much.

• More major operation: More major surgical procedures and serious injuries cause damage to blood vessels and activate the blood clotting (coagulation) system.

There are also various other factors that can increase someone’s risk of developing DVT:

• Previous DVT

• Being older than 60 years

• Family history (parents or siblings had a DVT)

• Certain types of cancer

• Heart failure

• Being severely overweight (obese)

• Taking the contraceptive pill

• Hormone therapy for menopause

• Very noticeable varicose veins

• Smoking

• Certain inflammatory diseases

• Pregnancy

• Regular long-haul journeys where you spend a lot of time sitting

Taken on their own, however, most of these risk factors only slightly increase the risk of DVT.

Prevalence

Studies have estimated that an average of about 1 out of 1,000 people develop noticeable (symptom-causing) deep vein thrombosis per year. The risk increases with age. It is somewhat more common in men than in women.

Effects

One common complication of DVT is known as post-thrombotic syndrome. People with this syndrome may have a swollen leg that feels heavy and hurts. The skin on their leg may also become discolored and itch, and a rash may develop. More severe cases of post-thrombotic syndrome can lead to the formation of chronic wounds.

Post-thrombotic syndrome occurs if the DVT has damaged the walls or valves of a vein, causing the blood to constantly build up in the vein. The syndrome often only develops several weeks or months after the DVT, sometimes even after one or two years.

Pulmonary embolism

A rarer but more serious complication of deep vein thrombosis is known as pulmonary embolism. This happens if the blood clot breaks away from its original site and is carried in the blood to the lungs, where it blocks a blood vessel. The symptoms of pulmonary embolism include:

• Sudden shortness of breath

• Chest pain (particularly when breathing in or coughing)

• Dizziness, lightheadedness or unconsciousness

• Rapid heartbeat

• Coughing up blood (rare)

Pulmonary embolism needs to be treated quickly because the blocked blood vessel causes blood to build up between the heart and lungs. This can put too much strain on the heart and eventually lead to life-threatening heart failure.

If pulmonary embolism develops, then it usually does so within two weeks of the DVT. The risk of pulmonary embolism is greater if the thrombosis is in the upper part of your leg or in your pelvis than if you have DVT in your lower leg. This is also true for thrombosis that causes very noticeable symptoms.

Diagnosis

Deep vein thrombosis can’t be diagnosed for sure based on typical symptoms alone. Symptoms such as pain, swelling and red skin can be caused by other things too, including an inflammation of superficial veins, varicose veins, erysipelas or narrow leg arteries (peripheral artery disease, or PAD).

To diagnose DVT, a blood test called a D-dimer test is usually done first. This test reacts to substances that are released when blood clots are broken down. The substances are called D-dimers. If the results of the test are normal, doctors can be quite sure that you don’t have DVT. If the results are abnormal, a special kind of ultrasound scan (a Doppler ultrasound) is done in order to confirm the diagnosis. Doppler ultrasounds provide information about the condition of the deep veins and blood flow in the veins.

If there’s good reason to believe that someone has a DVT, an ultrasound scan is usually done immediately. Examinations involving a small procedure are only rarely needed. One example is a special x-ray examination of the blood vessels which helps to see if there are any narrow areas (angiography). This involves injecting a contrast medium into the vein.

Prevention

There are different ways to try to prevent DVT. If someone has had surgery or was injured and has to stay in bed for a few days, it is important that they get up and start moving again as soon as possible. Even small movements like wiggling your feet are recommended in order to improve your circulation. If someone has an increased risk of DVT it can be a good idea for them to wear compression stockings or use medication too.

Compression stockings can lower the risk of deep vein thrombosis by applying pressure to the legs, which helps the blood flow back to the heart faster.

A third option is medication that reduces the clotting ability of the blood. This can be injected or swallowed. Medications that are injected into the skin or a vein already start working after a few hours. Examples include medications known as heparins and the drug fondaparinux.

There are two main kinds of oral medications, known as coumarins and direct oral anticoagulants (DOACs). DOACs are sometimes also called novel oral anticoagulants (NOACs). The best known coumarin is called phenprocoumon (known by many under the trade name Marcumar or Marcoumar). Examples of DOAC drugs include apixaban, dabigatran, edoxaban and rivaroxaban. Coumarins only start working after a few days, and direct oral anticoagulants already start working after a few hours.

Treatment

Deep vein thrombosis is usually treated in the hospital over several days, using the same medications that are used to prevent thrombosis. The treatment is started with a medication that works quickly, such as heparin.

To make sure that the blood clot dissolves completely, patients are advised to take anticoagulant (anti-clotting) tablets for three months after having acute treatment. Sometimes it’s a good idea to take them for even longer too.

For people who can’t take anticoagulants, an alternative option is having a small metal filter (known as an “inferior vena cava filter” or “IVC filter”) implanted in the large vein above the kidney. The filter is meant to catch any blood clots that could otherwise travel from the leg to the lungs. It is implanted using a venous catheter, in a procedure similar to cardiac (heart) catheterization.

The risk of post-thrombotic syndrome can be lowered by wearing compression stockings for up to two years.

Sources

• Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE). October 2015. (AWMF-Leitlinien; Volume 003 – 001).

• Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson MD et al; American College of Chest Physicians. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e351S-418S. [PMC free article: PMC3278048] [PubMed: 22315267]

• Deutsche Gesellschaft für Angiologie e.V. (DGA). Venenthrombose und Lungenembolie: Diagnostik und Therapie. S2k-Leitlinie. October 2015. (AWMF-Leitlinien; Volume 065 – 002).

• Encke A, Haas S, Kopp I. Prophylaxe der venösen Thromboembolie. Dtsch Arztebl Int 2016; 113(31-32): 532-538. [PubMed: 26934866]

• Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al; American College of Chest Physicians. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e278S-325S. [PMC free article: PMC3278063] [PubMed: 22315265]

• Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA et al; American College of Chest Physicians. Prevention of VTE in nonorthopedicsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e227S-77S. [PMC free article: PMC3278061] [PubMed: 22315263]

• Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA et al; American College of Chest Physicians. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e195S-226S. [PMC free article: PMC3278052] [PubMed: 22315261]

• Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ et al; American College of Chest Physicians. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl) :e419S-94S. [PMC free article: PMC3278049] [PubMed: 22315268]

• Sachdeva A, Dalton M, Amaragiri SV, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2014; (12): CD001484. [PubMed: 25517473]

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Treatment and rehabilitation of patients with deep vein thrombosis of the lower extremities | Bogachev V.Yu.

Implementation of an effective system of treatment and rehabilitation of patients with deep vein thrombosis (DVT) is one of the most urgent problems of modern clinical medicine. This is due to the steady increase in the frequency of DVT, which reaches 160 cases per 100,000 population per year. Such a high incidence is due to a change in the lifestyle of a modern person (physical inactivity, diet, overweight, etc.), an increase in injuries, an increasingly frequent occurrence of hereditary and acquired disorders of the hemostasis system, the prevalence of oncological diseases, uncontrolled intake of hormonal drugs, etc. Venous thrombosis with inadequate treatment leads to severe chronic venous insufficiency (CVI) of the lower extremities and disability. In addition, a real threat to the lives of many patients treated in hospitals of various profiles is pulmonary embolism (PE), the most dangerous complication of DVT.

The polymorphism of the clinical manifestations of DVT often requires a differential diagnosis with diseases that occur with similar symptoms (intermuscular hematomas, myositis, muscle strain, Achilles tendon injuries, arthrosis, arthritis, etc.). In this regard, there is a need to attract additional, instrumental methods of examination. The most informative are duplex ultrasound scanning of blood vessels and radiopaque phlebography. Doppler ultrasound in DVT has no independent diagnostic value, since it gives a large percentage of false-negative conclusions in non-occlusive forms of thrombosis.

Treatment program for DVT:

Treatment program for DVT includes:

1) Stopping the growth and spread of a blood clot.

2) Prevention of PE.

3) Restoration of the patency of the lumen of the vein.

Stopping the growth and spread of a blood clot can be achieved by anticoagulant therapy , which involves the sequential use of direct (heparin) and indirect (phenylin, acenocoumarol, etc.) anticoagulants.

In the absence of contraindications, conventional (unfractionated) heparin is prescribed at a daily dose of 450 IU per 1 kg of the patient’s body weight. Depending on the route of administration, a single dose is calculated by dividing the daily dose by the number of injections (8 injections for intravenous, fractional administration with an interval of 3 hours; 3 for subcutaneous administration with a frequency of 8 hours). To achieve the fastest possible anticoagulant effect, it is advisable to initially inject 5000 IU of heparin in a stream, and then the rest of the daily dose using an infusion pump.

The duration of heparin therapy is individual and averages 7-10 days. At the same time, the dose of heparin should be adjusted taking into account the time parameters of blood coagulation (optimally, their lengthening is 1.5 – 2 times from the norm), which are assessed daily before the next administration of the drug.

Currently, low molecular weight heparins (LMWH) are widely used for anticoagulant therapy of DVT. Their selective predominantly anti-Xa action prolongs the antithrombotic effect and reduces the incidence of hemorrhagic complications. In international practice, the most widely used enoxaparin . Enoxaparin is prescribed at a dose of 1 mg / kg 2 times a day under the skin of the abdomen. It should be emphasized that when using LMWH, daily laboratory monitoring of the hemostasis system is not necessary, which creates favorable conditions for the outpatient treatment of embolone dangerous DVT.

Indirect anticoagulants should be prescribed 3-4 days before the expected withdrawal of heparin. Their effective daily dose is controlled by the level of the prothrombin index, the value of which should be stabilized within 45 – 60%.

In recent years, for standardized monitoring of the effectiveness of anticoagulant therapy, the international index INR , which is the ratio between the patient’s prothrombin time (PTp) and the control prothrombin time (PTcontr.), has been used . The anticoagulant effect is considered achieved if the INR is more than 1.5 . The duration of taking indirect anticoagulants is usually 3-6 months, since it is during these periods that DVT recurrences are most often observed. In thrombophilic conditions, therapy with indirect anticoagulants should be longer.

Along with anticoagulants in the treatment of DVT, it is advisable to use hemorheologically active drugs (rheopolyglucin, pentoxifylline and nicotinic acid derivatives) and non-specific anti-inflammatory drugs (NSAIDs) parenterally or rectally (in suppositories). The need to use NSAIDs (preferably derivatives of diclofenac and ketoprofen) is due to the presence of inflammatory reaction from the venous wall, as well as pain syndrome, which makes it difficult for the patient to activate . Subsequently, for 4–6 weeks, drugs with a predominant anti-inflammatory effect on the venous wall (rutoside, troxerutin) should be prescribed.

With regard to antibiotics, their use in uncomplicated DVT is meaningless, as well as in varicothrombophlebitis. An exception can be made in the case of pustular skin lesions or the presence of “entrance gates” for infection (open fractures, surgical wounds, etc.), as well as for patients with a high risk of septic complications (diabetes mellitus, HIV, etc.).

For the prevention of PE, in addition to anticoagulant therapy, which to a certain extent prevents it by preventing the progression of thrombosis, various surgical methods are used for embolic (floating) thrombi : thrombectomy, implantation of a cava filter or plication of the inferior vena cava with a mechanical suture.

Complete restoration of vein patency in cases of early diagnosed (3-5 days old) segmental DVT is sometimes possible with the help of direct surgical intervention (thrombectomy) or thrombolytic therapy.

The period of active thrombus formation lasts on average about 3 weeks. It is shortened with adequate therapy or may be delayed if the treatment is not carried out correctly. The result of DVT in the vast majority of cases are post-thrombophlebitic changes in the venous system of the lower extremities.

Depending on the path of thrombus evolution, vein lumen recanalization may occur 0004 or its resistant obliteration. In some cases, recanalized vein segments alternate with occluded ones.

After DVT, the patient enters a qualitatively different pathological condition called post-thrombophlebitis disease (PTFD) . It is characterized by the development of chronic venous insufficiency syndrome and the rapid progression of trophic skin disorders, which necessitates a comprehensive rehabilitation program for DVT.

Injury to the vein wall may result from various injuries, surgeries and endovasal procedures . In accordance with this, preventive measures are also planned. A number of pharmaceutical preparations (anavenol, rutoside, diosmin, troxerutin, etc.) have a phleboprotective effect. To accelerate the flow of blood, periodic contractions of the muscles of the lower extremities are necessary. That is, patients are recommended an active motor mode with a restriction of static stay in an upright position. A rational dynamic load is necessary for all patients who have undergone DVT.

Firstly, physical exercises help to compensate for the activity of the cardiovascular system in general and venous outflow from the extremities in particular.

Secondly, muscle contraction provides an increase in the concentration of an important antithrombotic factor – tissue plasminogen.

Thirdly, weight control without rational physical exercises is problematic.

It is often believed among physicians and patients that any exercise after DVT is contraindicated. This position is wrong. Special gymnastics in a horizontal position has a positive effect on the rehabilitation of patients. It is necessary to exclude only those types where there is a static component or which can provoke leg injuries. In addition, all exercises should be performed under conditions of elastic compression of the lower extremities.

The load must be increased gradually. A daily 1.5-hour walk with occasional rest is enough to start. If the affected limb does not respond with pain or convulsive syndrome, the duration and frequency of walks can be increased. After 2-3 months, physical exercises can be expanded with gymnastics aimed at improving venous outflow from the limb. These are exercises in the supine position with raised legs (“birch”, “scissors”, “bicycle”, etc.). In the future, exercises on a stationary bike, jogging, cross-country skiing can be connected. In addition, swimming is advisable at all stages of rehabilitation, which is the best sport for patients with pathology of the venous system.

An important factor that improves phlebohemodynamic parameters is adequate, constant elastic compression . In particular, a 2-fold reduction in vein diameter achieved with its help leads to a 5-fold increase in blood flow velocity.

Compression treatment is prescribed for a long-term, and in some cases even a lifetime, period for all patients who have had DVT. In this case, special elastic bandages with a limited degree of extensibility or medical compression stockings can be used.

Elastic bandages suitable for long-term wear must be made from a dense fabric containing at least 50% cotton. Their distinguishing feature is extensibility in only one direction – along the length. The width must remain constant. The technique of applying a compression bandage should be taught to each patient. The bandaging of the limb should be carried out in a horizontal position (before getting out of bed) from the toes, with the obligatory grip of the heel in the form of a hammock, and each subsequent round of the bandage should cover the previous one by 2/3. The upper border of the elastic bandage should, if possible, overlap the proximal border of the affected venous segment by 10–15 cm.

Post-thrombotic lesion of the iliac and inferior vena cava determines the need to use special medical tights II and stockings III compression classes, providing the creation of therapeutic pressure in the range of 40 – 50 mm Hg. and more.

Patients often ask the question: do I need elastic compression only for the affected leg or do I need to bandage both? Thrombus spread to the inferior vena cava, conditions after cava filter implantation or cava plications that cause phlebohypertension in both limbs are an absolute indication for a bilateral elastic bandage. In addition, during the rehabilitation period, when the patient subconsciously spares the affected leg, elastic compression support for the healthy leg is advisable.

The use of systems of variable pneumomassage of extremities is promising. Creating under computer control the effect of a “traveling air wave”, these devices provide effective emptying of veins and lymphatic collectors. The compression bandage applied after this procedure fixes the therapeutic result. The course of treatment usually includes 20-30 sessions.

Physico-chemical disorders of the hemostasis system are the result of various congenital (genetic deficiency of antithrombin III, proteins C and S, erythremia, etc.) and acquired (liver failure, hypoproteinemia, hypovolemia, etc.) pathological conditions. Thrombotic readiness of the hemostasis system and DVT are provoked by various oncological diseases.

Postponed DVT is an absolute contraindication to hormonal contraception, and the question of hormone therapy for medical reasons should be decided strictly on an individual basis.

DVT, regardless of its cause, creates hemodynamic prerequisites for relapse. Its risk increases many times in case of trauma, surgical intervention, severe infectious or somatic disease. In all these situations, there are indications for preventive heparin therapy, with the preferred use of LMWH (enoxaparin, fraxiparin, etc.).

The problem of the consequences of DVT and pregnancy deserves a separate discussion. There is an opinion among doctors and patients that phlebothrombosis categorically excludes pregnancy and childbirth. Indeed, from a medical point of view, pregnancy in the first year after DVT is undesirable. Subsequently, a decision about it should be made by a woman after consultation with an obstetrician-gynecologist and an angiosurgeon. If DVT was not provoked by severe disorders of the hemostasis system, was not accompanied by massive pulmonary embolism, did not lead to severe hemodynamic disorders (for example, due to IVC occlusion), then there are no fundamental contraindications to pregnancy, although the risk of thromboembolic complications during it increases.

In this regard, the entire pregnancy of the patient should be under the close supervision of an obstetrician-gynecologist and phlebologist. From the first half of pregnancy, a therapeutic and protective regimen and a permanent elastic bandage are prescribed (best of all, special elastic tights of compression class II). As the duration of pregnancy increases, starting from the 2nd trimester, and depending on the severity of venous insufficiency, the issue of drug therapy can be resolved. Optimum are polyvalent phlebotonizing drugs, such as diosmin and troxerutin, in combination with antiplatelet agents (trental, aspirin-cardio, etc.). Pregnant women at high risk of thromboembolic complications should be admitted to the hospital a few weeks before delivery. The question of the method of delivery (naturally or via caesarean section) is decided individually during a joint consultation with a vascular surgeon. In the immediate postoperative period, it may be necessary to prescribe preventive anticoagulants.

Currently, there is no consensus on the advisability of combining indirect anticoagulants with hemorheologically active drugs and phleboprotectors on an outpatient basis. While hospitalized, patients with DVT usually receive a wide range of different medications. Therefore, in order to prevent various gastrointestinal and allergic reactions after discharge, it is advisable to take a 2-3-month break, during which the patient takes only indirect anticoagulants.

A gross mistake often made by polyclinic doctors and patients is the early cancellation of indirect anticoagulants and their repeated administration in short courses from 3–5 days to 2–3 weeks. In this case, an increase in the prothrombin index to 90-100% without any clinical symptoms is considered as a manifestation of thrombosis. It must be clearly understood that a high level of prothrombin in itself does not indicate phlebothrombosis, but is only a marker of the protein-synthetic function of the liver. In clinical settings, this figure can vary widely. The appointment of indirect anticoagulants in short courses with their rapid cancellation “looses” the hemostasis system and creates the prerequisites for “rebound” thrombosis.

After completion of indirect anticoagulants, a drug treatment program is planned to improve hemorheology, microcirculation and lymphatic drainage, as well as to relieve symptoms of venous insufficiency that reduce the quality of life. The physician planning treatment must clearly understand that DVT leads to irreversible changes in the venous bed. Therefore, the vast majority of patients need pharmacotherapy for a long time, for several years, and sometimes for life. The patient should also be informed about this.

Drug treatment should be course, with an average duration of 2.5 – 3 months, include a combination of drugs with different mechanisms of action. Depending on the severity of the disease, courses of treatment should be carried out at least 2-3 times a year, while for the prevention of complications from the gastrointestinal tract, it is advisable to administer some of the drugs parenterally or in the form of suppositories.

Pharmacotherapy is most often performed on an outpatient basis. Meanwhile, patients with severe forms of the disease who have undergone massive pulmonary embolism or thrombosis of the inferior vena cava, annual hospitalization in a therapeutic or cardiology department for a period of 2–3 weeks is advisable for infusion hemorheological and cardiotonic therapy.

For conservative therapy in patients who have had DVT, in addition to traditional derivatives of pentoxifylline, rutoside and horse chestnut extract, modern phlebotonic preparations should be widely used. These are diosmin, troxerutin, diovenor, cyclo-3 fort, endothelon. Their complex action allows administration in the form of monotherapy, which reduces the drug load on the patient’s body and the associated risk of various allergic and gastroenterological disorders. For example, a high degree of purification and a special micronization technology made possible long-term (up to 6 months or more) safe administration of Detralex, which had a positive effect on the quality of rehabilitation of patients with DVT.

When planning a program of conservative treatment, it is necessary to remember the seasonal nature of the course of the disease. The vast majority of patients note deterioration in the summer, when the heat and the associated violation of the compression regimen lead to decompensation of the venous outflow. To some extent, the course of drug therapy allows to neutralize the consequences.

Sanatorium treatment is planned to consolidate the results of pharmacotherapy. For patients who have had DVT, clinics with radon (Pyatigorsk) and hydrogen sulfide (Kislovodsk, Pyatigorsk, Sochi, Sergievsky Mineralnye Vody) thermal waters are optimal.

Therapeutic naphthalan and silt muds relieve persistent pain and edematous syndrome in most patients with the consequences of DVT.

General recommendations include rational nutrition is an important factor in controlling body weight, the excess of which exacerbates venous insufficiency. Patients who have had DVT and who are obese are advised to take measures, including medication, to lose weight. Spicy, fatty and salty foods should be excluded from the general diet, flour and sweet foods should be limited. It is advisable to diversify the menu with low-fat varieties of fish and meat, a large number of vegetables and fruits, and use mainly vegetable oil.

Some features of the diet should be taken into account when treating with indirect anticoagulants (phenylin, acenocoumarol, etc.). Foods rich in vitamin K (cabbage, spinach, sorrel, liver, coffee, etc.) should be excluded from the diet.

Fluctuations in intra-abdominal pressure during defecation have a negative effect on the vein wall. That is why an important part of the diet are foods that have a laxative effect (vegetable oil, beets, prunes, figs, bananas, etc.).

Certain requirements must apply to personal hygiene. Persistent phlebohypertension leads to disruption of the blood supply to the skin and overload of the lymphatic system. Under these conditions, the tolerance of the skin to various damaging factors, including microbial ones, is significantly reduced.

Clothing must be sufficiently spacious and comfortable. Undergarments should not be worn in tight panties in the form of “bottoms”, which compress the collateral venous outflow tracts at the level of the inguinal fold. For the same reasons, wearing tight-fitting trousers made of rough fabric is not recommended. Shoes should be comfortable, with low, stable heels.

A hygienic shower must be taken daily. In this case, it is advisable to douse each leg with a tight stream of warm and cool water alternately for 10 – 15 minutes.

A permanent elastic bandage, as a rule, leads to increased dryness of the skin, accompanied by its peeling and the formation of microcracks, which are the “gates” for infection. For the prevention of hyperkeratosis, nourishing creams and lotions should be used. In addition, it is necessary to prevent the formation of corns. Important is the prevention and timely treatment of mycotic lesions of the skin of the feet and nails.

It is necessary to limit the use of those types of hair removal that are accompanied by heating of the limb (paraffin wax), a significant violation of the integrity of the skin (mechanical) or exposure to damaging physical factors (laser, electric).

All patients with a history of DVT require clinical examination and examination for VTEC. Ideally, they should be attached to specialized phlebological or angiological centers. During the first year after DVT, the patient should visit the doctor at least 3 times. Subsequently, in the absence of complaints – 1 time per year. During follow-up examinations, the doctor evaluates the course of the disease, conducts a follow-up ultrasound examination, corrects the treatment program and gives recommendations for examination for VTEK.

VTEC plays an important role in the rehabilitation of patients. When conducting it, it is necessary to take into account the fact that patients who have had DVT are contraindicated in work associated with heavy physical exertion, prolonged stay in a static position (standing or sitting), exposure to adverse factors (hot shops, various types of radiation, sudden changes in temperature and etc.), high risk of limb injury. That is, the vast majority of patients in the first years after uncomplicated DVT need to be examined by VTEK on the basis of permanent disability with the assignment of II working or III disability groups. Depending on the course of the disease and the patient’s compliance with the rehabilitation program, labor activity can be expanded, and the disability group can be removed.

In conclusion, it must be emphasized that rational treatment and rehabilitation programs, selected individually, in each specific case of DVT, can effectively influence the thrombotic process, prevent the recurrence of the disease, and help the patient restore social and household activity.

Comprehensive rehabilitation program for DVT: • Reliable prevention of disease recurrence. • Compensation of venous outflow and prevention of PTF progression. • Social adaptation of the patient while maintaining his usual level of quality of life

Drug treatment should be course, with an average duration of 2. 5 – 3 months, include a combination of drugs

Deep vein thrombosis: symptoms, diagnosis and treatment

Deep vein thrombosis is a disease in which blood clots form in the deep veins, most often of the lower extremities. A blood clot is a blood clot that acts like a plug and clogs a vessel during thrombosis. Deep vein thrombosis (DVT) can occur at any age but is especially common in the elderly. This disease occurs in 10-20% of the population and is one of the most common and life-threatening disorders of the circulatory system.

Especially dangerous is DVT of the lower extremities, which is fraught with fatal complications. The detached blood clot travels with the blood stream to the lungs, where it blocks the blood flow, resulting in acute respiratory failure, chest pain, and even suffocation. This condition is known as pulmonary embolism and is often disabling and fatal.

Symptoms of DVT

In many cases, deep thrombosis is mild and asymptomatic. In many patients, DVT is detected already at the clinical manifestation of pulmonary embolism. According to medical observations, only 50% of patients show symptoms of DVT:

• Pain.
• Feeling of fullness and heaviness in the leg.
• Swelling of the leg or part of it.
• The temperature of the affected leg is slightly higher than that of the healthy leg.
• Change in skin color – pallor, cyanosis.

Most often, DVT occurs in the lower extremities, especially in the calves of the legs, less often in the veins of the pelvis.

Causes of DVT

Doctors identify three main causes leading to the formation of a blood clot:

1. Decrease in the speed of venous blood flow – in case of a forced immobile state, the normal process of blood movement through the vessels is disturbed, and conditions are created for the formation of a blood clot.
2. Changes in blood clotting – hypercoagulability (increased clotting) leads to the fact that blood cells stick together.
3. Damage to the venous walls – mechanical deformation creates conditions for the formation of a blood clot.

Risk factors

• Old age.
• Surgical interventions.
• Obesity.
• Injuries and fractures of the lower extremities.
• Prolonged immobility – paralysis, bed rest.
• Pregnancy and the postpartum period.
• Oral contraceptive use and hormone therapy.
• Sitting for a long time – air travel, car travel, sedentary work.
• Varicose veins of the lower extremities.
• Oncological diseases, chemotherapy – they often increase blood clotting.
• Diseases of the lungs.
• Heart failure.
• Ischemic stroke.
• Acute infections, sepsis.
• Blood diseases.
• Congenital vascular diseases – varicose veins, insufficient functionality of the venous valves, weak walls of the veins.
• Hereditary predisposition.
• Smoking.
• Strong physical activity, weight lifting.

DVT in the elderly

DVT is the most common vascular disease in the elderly. Age itself is an increased risk factor for developing DVT, as older people tend to have increased blood clotting, fragility of the vascular walls, and the presence of acquired diseases and past injuries. The number of patients increases with aging, and if the average number of cases of DVT is 160 people per 100 thousand, then among people over 80 this figure increases to 450-600. In the elderly, the course and progression of this disease is aggravated by age-related problems, such as decreased muscle mass, difficulty with movement, reduced ability to self-care, cognitive impairment, blurring of symptoms against other diseases. Most often, DVT in the elderly develops after surgery, trauma, heart attacks, and strokes that lead to prolonged bed rest.

Timely diagnosis of the disease is hampered by the presence of other pathologies, as well as possible cognitive impairment. This leads to the fact that older patients rarely seek help on time, so older people are more likely to experience complications, primarily pulmonary embolism, which is most often fatal. Another complication of DVT, which is typical for age-related patients, is post-thrombotic syndrome, which develops within 10 years in 50% of patients. It leads to chronic venous insufficiency – impaired venous outflow of blood through the deep veins of the lower extremities – which manifests itself in heaviness in the legs, swelling, pain, hyperpigmentation, and trophic ulcers appear in the later stages.

Diagnosis of DVT

This is a very dangerous disease, therefore, at the first symptoms and suspicion of a disease, you should consult a phlebologist. The doctor asks the patient about symptoms, conducts a visual examination of the legs, noting swelling, changes in skin color and temperature, palpates the limbs to identify painful areas.

To clarify and confirm the diagnosis, the doctor prescribes instrumental diagnostics and tests. First of all, you need to undergo an ultrasound of the deep veins of the lower extremities. This study allows you to assess the condition of the veins, find damage and determine the localization of the blood clot. A blood test for DVT is called a D-dimer test. This test shows the presence of a protein fragment, which is formed during the dissolution of blood clots, as well as during the formation of blood clots, the process of their dissolution is simultaneously launched. In some cases, if ultrasound does not give a complete picture, the phlebologist may prescribe phlebography – a study with the introduction of contrast into the veins, which allows you to assess the condition of the veins and valves, their patency and the presence of blood clots on the x-ray.

Treatment

DVT of the lower extremities is an indication for hospitalization. Only in a hospital setting can you stop the growth of a thrombus, prevent its separation and complication in the form of pulmonary embolism. During hospitalization, the patient undergoes a course of drug treatment, which includes drugs that thin the blood, dissolve blood clots and strengthen the walls of blood vessels, ointments with anti-inflammatory and analgesic effects. Simultaneously with drug therapy, special compression underwear (stockings, stockings, tights) is used. The size and degree of compression is selected by the doctor. In severe cases – with a separation or threat of separation of a blood clot, a high risk of pulmonary thromboembolism – surgical intervention is necessary.

Elderly patients need a special approach that takes into account concomitant diseases and the general condition of all body systems of an elderly person. For such patients, for the duration of bed rest, massage of the chest and a healthy limb is prescribed, breathing exercises are recommended to prevent congestive pneumonia, and hygiene procedures are carried out to prevent the formation of bedsores. Bed rest should be observed until the danger of further thrombus formation, its separation and thromboembolism disappears.

Keep your legs elevated during bed rest to improve blood flow and reduce swelling. To do this, use functional beds with an adjustable lower part, which is raised by 15-20 degrees.

In addition to compression garments, bedridden patients may receive pneumatic compression. It is carried out using a special compressor and cuffs, divided into chambers, which are worn on the limbs. The chambers are sequentially filled with air and put pressure on the tissues and vessels of the legs, simulating the work of muscles and stimulating blood circulation. As a result, in an immobile patient, the speed of venous blood flow increases and the risk of blood clots decreases.

Prevention of DVT

Measures to prevent DVT are based on the fact that the main causes of thrombosis are low venous blood flow and increased blood clotting. Therefore, prevention is aimed at accelerating blood flow and normalizing blood coagulation (clotting) parameters.

Preventive measures are divided into physical and pharmacological. Pharmacological measures are the administration of prophylactic doses of anticoagulants to people at high risk of developing DVT. But doctors warn that in elderly patients, while taking these drugs, there may be a risk of bleeding.

Physical prevention methods include:

• Early activation of patients after surgery.
• Therapeutic exercise.
• Wearing compression stockings.
• Pneumatic massage.
• Compliance with the drinking regime (2.5 liters of water per day).
• Weight normalization.
• Smoking cessation.
• Contrast shower to strengthen the walls of blood vessels.

There is no special diet for DVT, but there are foods that help strengthen the walls of blood vessels: these are fish, seafood, fruits (especially pomegranate and apples), vegetables, berries, almonds, cereals. It is also recommended to limit foods that promote blood clotting – broccoli, offal, spinach, bananas, buckwheat, legumes.