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Causes for blood clots in legs: Deep vein thrombosis (DVT) – Symptoms and causes

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What Causes Blood Clots? – Symptoms

What are blood clots?

Blood clots are differently sized clumps of blood that have formed inside your body. Clotting is important to prevent excessive bleeding if you are injured or cut. However, when a blood clot blocks blood flow to important areas of your body, it can be harmful, even deadly. Blood clots can occur in your arms and legs, abdomen (stomach), heart, lungs, brain, and kidneys.

There are two different types of blood clots. These include clots that stay in place and don’t move (thrombosis) and those that break away from the spot where they developed and move to different areas inside your body (embolism). Depending on what the clot blocks or where it moves, a blood clot can be deadly.

Blood clot symptoms

Symptoms are different depending on where the blood clot is located. If the clot is in your arms or legs, you may experience pain (that feels like an intense cramp), swelling, and tenderness. Your skin may be red and warm to the touch where the clot is located. If the blood clot is in your abdomen, you may experience severe stomach pain, vomiting, and diarrhea.

Blood clots that travel to your heart cause a heavy feeling or pain in your chest, pain in your upper body, shortness of breath, sweating, nausea, and light-headedness. If the clot moves to your lungs, you could experience sharp chest pain, a racing heart, shortness of breath, sweating, and fever. You may cough up blood. A blood clot in the brain may cause weakness in your face, arms, or legs, speech and vision difficulties, headache, and dizziness. Many of these symptoms are the symptoms associated with other conditions, such as heart attacks and stroke.

If you suspect you have a blood clot, see a doctor immediately.

What causes blood clots?

Your body reacts to an injury or cut by clotting your blood just the way it should. These types of clots are not a problem. Sometimes a blood clot will form without a trigger (such as an injury or cut). This is more likely to happen with certain risk factors or conditions. Risk factors include:

  • Prolonged sitting (often the case with travel when you are forced to sit for long periods in an airplane, a train, or a car)
  • Prolonged bed rest (often the case with surgery or illness)
  • Pregnancy
  • Smoking
  • Obesity
  • Birth control pills/hormone replacement therapy/breast cancer medicines
  • Certain cancer types (pancreatic, lung, multiple myeloma, or blood-related cancers)
  • Trauma (serious injury)
  • Some types of major surgery
  • Age (especially over the age of 60)
  • A family history of blood clots
  • Autoimmune disorders
  • Diseases related to chronic inflammation
  • Certain infections (HIV/AIDS, hepatitis C, or Lyme disease)

How are blood clots diagnosed?

Whether you go to your doctor’s office or an emergency room, the doctor will examine your symptoms. The doctor also will ask you about your medical history, your family’s medical history, and the medicines you are taking. The doctor may order a blood test to send to the lab. A blood test also can diagnose an autoimmune disorder or certain infections. The test involves inserting a small needle into a vein in your arm to draw a sample of blood. There are several lab tests that can check for abnormal clotting and for the presence of antibodies that interfere with clotting.

Can blood clots be prevented or avoided?

Blood clots are highly preventable. To prevent or avoid a blood clot, know your personal risk factors and control the risks you can. For example, if you smoke, stop. If you are obese, lose weight. If you take birth control pills, talk to your doctor about an effective alternative. If you are inactive, get moving. If you have a family history of blood clots, talk to your doctor. Your doctor may determine whether you should be taking blood-thinning medicine to prevent clots.

There are several situations in life that increase your risk for blood clots. These include:

  • When you are pregnant
  • When you are immobile
  • When you have just had major surgery
  • When you have cancer

Blood clot treatment

A blood clot is treated based on where it is located. Oral blood thinner medicines are the most common treatments for blood clots. Some medicines can be given through a catheter (a long, thin tube) inserted into the area of the clot. Some clots can be surgically removed. Talk to your doctor if you are pregnant. Medicines may involve risks to your unborn child. If your blood clot is due to an infection, your doctor may be able to treat the infection and reduce the risk of a clot.

Living with blood clots

If detected early, a blood clot can usually be treated successfully. If it was not treated early, your quality of life depends on the seriousness of the damage. For example, a blood clot can cause stroke, even death. If you’ve successfully survived a blood clot, you may live with the fear of having another. In that case, living with blood clots involves focusing on prevention. If you are being treated with blood thinner medicines, you have to be careful not to cut yourself (even when shaving). The medicine can make it difficult to stop the bleeding.

Questions to ask your doctor

  • How can I tell the difference between symptoms of a blood clot and another condition?
  • How much time does it usually take for a blood clot to travel to a danger zone once it breaks apart?
  • If I have one of the risk factor diseases or conditions, should I be taking a blood thinner?
  • How do I know if I need to see a doctor if I cut myself while taking blood thinner medicine?
  • Can a blood clot be passed through your urine or stool?

Resources

American Society of Hematology: Blood Clots

Centers for Disease Control and Prevention: Understanding Blood Clots

Thrombosis (Blood Clots) | Boston Children’s Hospital

Listen

Thrombosis is a blood clot that develops within veins or sometimes arteries in the body. Thrombosis may be serious or inconvenient but often occurs as a complication of a procedure, medication, or other disease. If left untreated a thrombosis can cause long-term problems; such as chronic swelling, pain, or even permanent damage to internal organs.

Thrombophilia refers to anything that increases one’s tendency to develop blood clots. Thrombosis in children is uncommon and is most often seen in children with complex medical problems or procedures. Thrombophilia can be considered the opposite of hemophilia, a disorder that prevents blood from clotting.

How is thrombophilia classified?

Thrombophilia refers to a group of disorders that increases a child’s tendency to develop dangerous blood clots. There are two main types of thrombophilia:

  • Inherited thrombophilia is caused by certain genetic conditions.
  • Acquired thrombophilia is caused by lifestyle factors or medical conditions, including immobility, obesity, sedentary lifestyle, trauma, smoking, or oral contraceptive use.

How we care for thrombosis

Children and young adults with blood clots are treated through the Dana-Farber/Boston Children’s Thrombosis and Anticoagulation Program. Through our unique program, we can quickly identify children who need anticoagulation medications (or “blood-thinners”) using established monitoring and risk identification guidelines. Children outside of the hospital visit our outpatient center staffed by pediatric hematologists and pediatric hematology nurse practitioners with specialized expertise in the diagnosis and treatment of thrombosis.

Our areas of research for thrombosis

For many children with rare or hard-to-treat conditions, clinical trials provide new options. Participation in any clinical trial is completely voluntary. We will take care to fully explain all elements of the treatment plan prior to the start of the trial, and you may remove your child from the medical study at any time. Currently, our hematology team is studying several new oral blood thinners in children for treatment and prevention of blood clots. We are also involved in an international study of the length of anticoagulation needed to treat thrombosis. Your hematologist may mention opportunities to participate in these studies, but you should feel free to ask about current research studies relevant to your child.

Researchers at Dana-Farber/Boston Children’s perform scientific and clinical research on platelets and related aspects of hemostasis and thrombosis. A particular focus is antiplatelet therapy, including the characterization of:

  • how newly discovered molecules and mechanisms could help control platelets and clotting
  • how antiplatelet drugs affect normal blood clotting (coagulation) and aspects of the immune system (e.g., inflammation)
  • the relationship between the strength of antiplatelet treatments and the balance between thrombosis (uncontrolled clotting) and hemorrhage (uncontrolled bleeding)
  • how tests of platelet function could help guide antiplatelet therapy in the clinic

Thrombosis | Symptoms & Causes

What are the symptoms of thrombosis?

Thrombosis symptoms in children can vary significantly depending on the size and location of the blood clot, and each child may experience symptoms differently. A thrombosis may occur anywhere in a child’s body, but most are in the legs or arms (deep-vein thrombosis or DVT) or lungs (pulmonary embolism). Other types of thrombosis include sinus venous thrombosis and arterial thrombosis.

Children with a thrombosis in the legs or arms may have the following symptoms:

  • swelling
  • pain
  • redness and warmth
  • low-grade fever
  • in some cases, you may even be able feel the clot, like a knot or rope under the skin

If a child has a pulmonary embolism, they may experience:

  • chest pain
  • shortness of breath, often beginning suddenly

A pulmonary embolus is a life-threatening medical emergency, and you should seek help immediately if you suspect this condition in your child.

It is important to understand that some thrombosis symptoms may resemble those of other more common medical problems. Because some of these symptoms can also point to other conditions, it’s important to have your child evaluated by a qualified medical professional for an accurate diagnosis and prompt treatment. If you have a family history of thrombosis, it is important to bring this up during evaluation for these symptoms.

What causes thrombosis?

There are three categories of causes of thrombosis: damage to the blood vessel (catheter or surgery), slowed blood flow (immobility), and/or thrombophilia (if the blood itself is more likely to clot).

Causes of thrombosis depend on whether your child has inherited or acquired thrombosis. Inherited thrombophilia is caused by certain genetic conditions while acquired thrombophilia is caused by lifestyle factors or medical conditions.

Possible factors for acquired thrombophilia include:

  • immobility
  • obesity
  • sedentary lifestyle
  • trauma

In teens and adults, risk factors also may include smoking or oral contraceptive use. Some patients with chronic inflammation or rheumatologic disorders may develop antiphospholipid antibody syndrome, a disorder where antibodies produced by the patient cause thrombosis to occur.

Thrombosis | Diagnosis & Treatments

How is thrombosis diagnosed?

The first step in treating your child is forming an accurate and complete diagnosis. If thrombosis is suspected, imaging is done to confirm the diagnosis and to define where the blood clot starts and ends. Thrombosis is sometimes found accidentally but mostly because patients develop signs and symptoms of a blood clot. 

If your child is suspected of having a thrombosis, diagnostic tests may include:

  • a physical examination to evaluate symptoms of a blood clot
  • ultrasound, an imaging technique that uses high frequency sound waves and their echoes to make images of the inside of your child’s body
  • magnetic resonance imaging (MRI), an imaging exam that uses a large magnet, radio waves, and a computer to produce two- and three-dimensional images of your child’s body’s organs, tissues, and bones
  • computed tomography (CT or CAT) scan, a non-invasive procedure that uses X-ray equipment and computers to create detailed, cross-sectional images of your child’s body
  • analysis of blood samples to evaluate whether your child’s blood is clotting normally and identify any abnormalities in the levels of certain proteins
  • genetic tests may be performed to check for hereditary disorders (inherited thrombophilia)

There may be other diagnostic tests your doctor will discuss with you depending on your child’s individual situation. After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will meet with you and your family to discuss the results and outline the best possible treatment options.

What are the treatment options for thrombosis?

Your child’s treatment team will determine a specific care plan. In most cases, thrombosis is treated with anticoagulation medications (blood thinners). These medications prevent the clot from growing and decrease the risk of its breaking apart and causing further complications. Your child may need to continue taking these medications for several months after initial treatment.

Examples of anticoagulation medication your child’s physician may prescribe include:

  • injections under the skin (also called subcutaneous injections) of a low molecular weight heparin such as enoxaparin (Lovenox) or dalteparin (Fragmin)
  • oral agents such as warfarin (Coumadin)
  • intravenous heparin
  • antiplatelet agents such as aspirin, clopidogrel (Plavix), or prasugrel (Effient)

Other treatments may include wearing compression stockings, remaining active, and applying warm packs to improve blood flow and pain caused by the clot.

Of course, your child’s team of doctors will help determine the best approach for your child’s unique situation, based on a number of factors, including:

  • your child’s age, overall health, and medical history
  • the severity of the disease
  • your child’s tolerance for certain medications, procedures, or therapies
  • how your child’s doctors expect the disease to progress
  • your opinion and preferences

What is the long-term outlook for children with thrombosis?

Some deep vein thromboses may resolve without treatment. Treatment is given to help get rid of the blood clot and to minimize complications of thrombosis. If the blood clot remains, other veins will enlarge to bypass the blockage. Sometimes these veins are visible, like varicose veins. After a blood clot some people develop long-term pain and swelling in the leg called post-thrombotic syndrome, which is caused by reduced blood flow and damage to the affected vein. Some patients also have changes in skin color, which may not develop for a year or more afterward.

Blood clots in the thigh are more likely to break off and travel to the lungs than blood clots below the knee or in the arms. A pulmonary embolism can be a life-threatening emergency, requiring immediate medical attention.

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Causes of thrombosis and inflammation of a thrombus

Thrombophlebitis is an inflammation of a thrombus located in the lumen of a venous vessel. The disease is a vicious circle: inflammation of the vein contributes to the increase in blood clot, and the processes occurring inside the blood clot increase inflammation.

The main cause of vein thrombosis is varicose veins. There are other factors that can cause complete or partial blockage of the venous vessel. All of them can cause life-threatening complications that are difficult to treat. It is best to know the possible causes of the disease, to prevent them.

If a superficial vein is affected, thrombophlebitis is called superficial. When a deep vein is blocked, thrombophlebitis will be called deep. Often, the process begins with superficial vessels, and then goes into the deep vein system.

Both types of disease, regardless of the cause of thrombophlebitis of the lower extremities, are complicated by chronic venous insufficiency. It, progressing, is manifested by darkening of the skin, edema, poorly healing trophic ulcers. The most dangerous complication is the separation of a blood clot with its subsequent entry into the pulmonary artery system or into the cerebral vessels. But if the treatment of thrombosis and thrombophlebitis was started on time and taking into account the cause of the disease, such consequences can be avoided.

Causes of pathology

Doctors name the following causes of thrombophlebitis. These are:

  • Varicose veins of the lower extremities, in which the blood flow in the dilated areas is so slowed down that all the conditions for thrombosis occur. This cause accounts for 70% of all superficial thrombophlebitis.
  • Injury to the venous wall. Superficially located veins can be injured by impact, friction with bone fragments, and falling. Also, their puncture and catheterization is considered an injury, which is also carried out on the legs. In response to injury to the wall, its components are activated, which cause the formation of a thrombus in the damaged area.
  • Prolonged immobilization, especially due to the need to consolidate the fracture. While the deep veins continue to provide outflow from the limbs, the superficial ones are partially compressed by plaster, blood flow slows down in them, and as a result, a blood clot forms.
  • Condition after treatment of varicose veins with sclerotherapy.
  • Chronic asymptomatic carriage of bacteria when they are in the bloodstream and can inflame existing blood clots.
  • Clotting diseases.
  • Increased blood estrogen concentration.
  • Vasculitis, including lupus.
  • Pancreatic, lung, stomach cancer causing migratory thrombophlebitis.
  • Increase in the level of homocysteine ​​in the blood.
  • Diseases of the liver in which the level of heparin in the blood decreases.
  • Homocystinuria.
  • Antiphospholipid syndrome.

The main cause of deep vein thrombosis in the lower extremities is called varicose veins. This condition develops as a complication of superficial thrombophlebitis, when a thrombus grows in the direction of the communicating veins (connecting the superficial system with the deep one), and, destroying their valves, breaks into the deep veins.

When smoking, taking contraceptives, obesity, as well as anomalies of the vascular wall, the risk of thrombophlebitis increases several times.

causes, symptoms, signs, diagnosis, treatment, prevention

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Thrombophlebitis is a chronic disease of the circulatory system, in which, after damage to the inner wall of the vein, an inflammatory reaction develops.

It is characterized by the rapid appearance of blood clots in this place due to the adhesion of platelets when passing through the inflamed area. As a result, a thrombus forms here, blocking the vessel and disrupting blood flow.

The incidence of the disease depends on many factors, and one of them is age. In people under 30 years of age, pathology is extremely rare, but in patients after 60 years of age it is one of the most frequently diagnosed pathologies, and in most cases these are women.

Causes and provoking factors of thrombophlebitis

Thrombophlebitis of the lower extremities, and this variant of the disease is more common than others, in 60% of all cases occurs as a concomitant disease of varicose veins. The main cause of pathology at a young age is thrombophilia.

Other provoking factors include:

  • pregnancy;
  • hormone replacement therapy;
  • long-term use of oral contraceptives without the consent of a doctor;
  • smoking;
  • thrombocytopenia;
  • both fungal and bacterial infections;
  • excessive body weight;
  • oncological formations;
  • advanced age;
  • long wearing of a cast or bed rest;
  • long-term use of cytostatics.

Recent studies have shown that genetics is of great importance in the development of venous thrombophlebitis, and thrombophilia comes to the fore, in which platelets stick together without damaging the venous wall.

What is the difference between thrombophlebitis and varicose veins? With varicose veins, only the expansion of the vein occurs, and thrombophlebitis is characterized by its blockage by a thrombus.

Classification of thrombophlebitis

Thrombophlebitis of the veins of the legs has a certain classification, which is associated with the depth of the lesion, localization, duration of the course.

According to the depth of the lesion, deep thrombophlebitis and superficial thrombophlebitis are distinguished. By localization, it can be local or migratory, when the inflammatory process moves through the vein.

The duration of the lesion is acute or chronic, with periodic exacerbations. Three forms of thrombi are distinguished by blocking the vein:

  • occlusive, when the blocking of the vein by a blood clot occurs completely, and there is a risk of gangrene;
  • ischemic, when a thrombus and edema from inflammation completely block the vessel, and necrosis of nearby tissues develops;
  • non-occlusive, when inflammation, swelling and thrombus do not completely block the blood flow, but it slows down, and tissue nutrition becomes difficult.

For reasons of development, thrombophlebitis is divided into 4 groups:

  • the first – varicothrombophlebitis, which occurs with existing varicose veins;
  • the second is post-injection, occurring at the injection site of an intravenous drug from a needle;
  • the third is infectious, developing due to the development of pathological microflora in the lesion;
  • the fourth – aseptic, when inflammation occurs without the participation of microorganisms.

Symptoms of thrombophlebitis

Thrombophlebitis has specific symptoms, but they will depend on the location of the affected vessel. If the pathology appears against the background of varicose veins, the veins of the legs are most often affected. The main manifestation is painful dense purple subcutaneous cords, as well as redness, increased pain during palpation.

If the inflammation is strong enough, the described symptoms are accompanied by redness, fever in this place, swelling. The most dangerous location of such inflammation is the knee, popliteal region and femoral part of the leg.

Another sign of thrombophlebitis is that if you lower your legs down to the floor, they immediately experience bursting pain. Edema in this case begins with the lower part of the leg, and then rises higher.

Acute thrombophlebitis is of particular danger, because it can suddenly disrupt the blood supply to the legs and possibly form emboli, and this is life-threatening. The main manifestation is a tense swelling of the leg with sharp, persistent pain. In the future, the swelling goes higher, can spread to the inguinal region and even to the lower abdomen.

If a thrombus forms in the inferior vena cava, there is intense swelling of the lower torso and legs. The veins of the anterior abdominal wall at the same time expand, there is a risk of developing thrombosis of the vessels of the liver and kidneys.

Superficial thrombophlebitis on the hands usually occurs after trauma to the vessel wall during an injection or insertion of a venous catheter. Typical manifestations begin in the antecubital fossa. The main symptoms are soreness, the appearance of compaction, redness, swelling along the vessel. However, such a lesion never affects the deep veins.

Complications of thrombophlebitis

The main danger of thrombophlebitis is that a blood clot can break off at any moment and go through the vessels along with the blood. If it enters the pulmonary artery, it will cause PE, which causes death. If a blood clot enters the coronary vessels, a heart attack can develop, and a stroke can develop into the vessels of the brain.

Thrombophlebitis diagnostics

When the first symptoms of the disease appear, it is necessary to contact a phlebologist or a vascular surgeon. If a pulmonary embolism is suspected, the best diagnostic option is a spiral CT scan of the chest, which can detect any, even small abnormalities.

Angiopulmonography is another method for diagnosing thrombophlebitis, when a contrast agent is used to examine a branch of the pulmonary artery. If deep thrombophlebitis develops, ultrasound is effective. Also, this study helps to quickly identify the disease during pregnancy and before childbirth.

Ultrasound is best performed in conjunction with Doppler, which allows you to understand exactly how blood moves through the vessels and at what speed it moves. To detect blood clotting disorders, a coagulogram is performed, which allows you to identify genetic breakdowns, due to which platelets themselves begin to stick together with each other. Sometimes it is recommended to determine the blood D-dimer.

Treatment of thrombophlebitis

A few years ago, the best treatment for thrombophlebitis was crossectomy, but as recent studies have shown, this operation is too traumatic and causes many dangerous complications.

Therefore, today the ideal option is thrombectomy, and the operation for thrombophlebitis is performed under general anesthesia. However, it all depends on the location of the thrombus and its size.

Scoping helps expand the vein and improve blood flow in it. And a method called “Invagination stripping” helps to remove a blood clot from even the most inaccessible areas.

At the initial stage of the disease, according to the doctor’s prescription, patients can take special medicines. The main drugs for thrombophlebitis are anticoagulants that thin the blood and prevent its clotting. With the infectious nature of inflammation of the veins, antibiotics are prescribed. To improve the tone of the veins and reduce stagnation in them – angioprotectors. Antiplatelet agents, phlebotonics are also used, and non-steroidal analgesics are used to relieve pain.

According to the latest clinical guidelines, thrombophlebitis can also be treated with a laser. This safe, low-traumatic technique helps to get rid of ascending thrombophlebitis.

Other effective therapies include intermittent pneumocompression and electromyostimulation with the Veinoplus device. But gymnastics and active physical exercises should be abandoned, as this can cause a blood clot to break off and enter large vessels. Do not rely on hirudotherapy (treatment with leeches) – this method has too low efficiency. As for nutrition, it remains the same, however, if there is excess weight, it is better to get rid of it.

What is forbidden to do with thrombophlebitis of the lower extremities? In order for the treatment to be truly successful, as a preventive measure to prevent exacerbation of thrombophlebitis, you should stop wearing high-heeled shoes and bad habits. You should not go to the bath or sunbathe diligently and, of course, you should not wear socks, stockings or stockings with a tight elastic band – this provokes the development of edema. You need to lead a healthy lifestyle, choose shoes according to size and avoid hypothermia.

The author of the article:

Magomedov Maksud Gadzhievich

head of the inpatient department at Krasnye Vorota metro station, KMN, phlebologist, proctologist

work experience 24 years

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