How is venous thromboembolism diagnosed. What are the treatment options for DVT and PE. Why are imaging tests crucial for accurate diagnosis of blood clots. Which medications are commonly used to treat venous thromboembolism. When are thrombolytics or surgical interventions necessary for blood clots.

Understanding Venous Thromboembolism: DVT and PE Explained

Venous thromboembolism (VTE) is a serious condition that encompasses two primary manifestations: deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in the deep veins, typically in the legs, while PE is a potentially life-threatening complication that arises when a clot breaks loose and travels to the lungs.

Is it possible to confuse VTE with other conditions? Indeed, several conditions can mimic the signs and symptoms of DVT and PE. For instance:

• Muscle injuries
• Cellulitis (a bacterial skin infection)
• Superficial thrombophlebitis (inflammation of veins just under the skin)
• Heart attacks
• Pneumonia

Due to these potential misdiagnoses, specialized imaging tests are essential for accurately identifying blood clots in the veins or lungs.

Diagnostic Techniques for Deep Vein Thrombosis (DVT)

Accurate diagnosis of DVT is crucial for timely and effective treatment. Healthcare professionals employ several diagnostic methods to confirm the presence of blood clots in deep veins:

Duplex Ultrasonography: The Gold Standard

Duplex ultrasonography stands as the primary imaging test for diagnosing DVT. How does it work? This non-invasive technique uses sound waves to visualize blood flow in the veins, effectively detecting blockages or clots in deep veins.

D-dimer Blood Test: A Preliminary Screening Tool

The D-dimer blood test measures a substance released when blood clots break down. A negative D-dimer result typically indicates the absence of a blood clot, making it a valuable initial screening tool.

Contrast Venography: The Most Accurate but Invasive Option

While contrast venography is considered the most precise test for diagnosing blood clots, its invasive nature has led to its limited use. This procedure involves injecting a contrast dye into a foot or ankle vein to visualize the deep veins in the leg and hip via X-ray imaging.

Advanced Imaging Techniques: MRI and CT Scans

Magnetic resonance imaging (MRI) and computed tomography (CT) scans can provide detailed images of veins and clots. However, these methods are not routinely used for DVT diagnosis unless specific circumstances warrant their use.

Diagnostic Approaches for Pulmonary Embolism (PE)

Pulmonary embolism, a potentially fatal condition, requires prompt and accurate diagnosis. Several specialized tests are employed to detect blood clots in the lungs:

Computed Tomographic Pulmonary Angiography (CTPA): The Standard Imaging Test

CTPA has emerged as the go-to imaging test for diagnosing PE. This specialized X-ray procedure involves injecting contrast dye into a vein, allowing for detailed visualization of blood vessels in the lungs.

Ventilation-Perfusion (V/Q) Scan: An Alternative Approach

The V/Q scan uses a radioactive substance to assess both oxygen supply (ventilation) and blood flow (perfusion) in the lungs. This test is particularly useful when CTPA is unavailable or contraindicated for certain patients.

Pulmonary Angiography: The Most Accurate but Invasive Test

While pulmonary angiography provides the most precise diagnosis of PE, its invasive nature limits its use to specific cases. The procedure involves inserting a catheter into a large vein and navigating it to the lung arteries before injecting contrast dye.

Magnetic Resonance Imaging (MRI): A Specialized Option

MRI can provide detailed images of the lungs without radiation exposure. It is typically reserved for certain patient groups, such as pregnant women or those who cannot receive contrast material.

Treatment Options for Venous Thromboembolism

Once diagnosed, prompt treatment of VTE is essential to prevent complications and reduce the risk of recurrence. The primary treatment approaches include:

Anticoagulant Therapy: The Cornerstone of VTE Treatment

Anticoagulants, commonly known as “blood thinners,” are the most frequently used medications for treating DVT and PE. Despite their name, these drugs do not actually thin the blood. Instead, they reduce the blood’s ability to clot, preventing existing clots from growing and reducing the risk of new clot formation.

Which anticoagulants are commonly used for VTE treatment? The most frequently prescribed options include:

1. Injectable anticoagulants:
   • Unfractionated heparin (administered intravenously)
   • Low molecular weight heparin (LMWH) (injected subcutaneously)
   • Fondaparinux (injected subcutaneously)
2. Oral anticoagulants:
   • Warfarin
   • Dabigatran
   • Rivaroxaban
   • Apixaban
   • Edoxaban

It’s important to note that all anticoagulants carry a risk of bleeding. Therefore, patients taking these medications require careful monitoring to prevent unusual bleeding episodes.

Thrombolytic Therapy: Breaking Down Clots in Severe Cases

Thrombolytics, often referred to as “clot busters,” work by actively dissolving blood clots. Due to their higher risk of causing bleeding compared to anticoagulants, thrombolytics are typically reserved for severe cases of VTE.

Inferior Vena Cava (IVC) Filter: A Mechanical Approach

In cases where anticoagulants are contraindicated or ineffective, an IVC filter may be inserted. This device is placed inside the inferior vena cava, a large vein that returns blood to the heart, to capture or trap any emboli (moving clots) before they can reach the lungs.

Surgical Interventions: Thrombectomy and Embolectomy

In rare and severe cases, surgical removal of the clot may be necessary. Thrombectomy involves removing a clot from a vein, while embolectomy refers to the removal of a clot from an artery in the lung.

Preventing Venous Thromboembolism: Risk Factors and Strategies

Understanding the risk factors for VTE is crucial for prevention. Common risk factors include:

• Prolonged immobility (e.g., long-distance travel, bed rest)
• Recent surgery or trauma
• Obesity
• Pregnancy and postpartum period
• Use of certain medications (e.g., birth control pills, hormone replacement therapy)
• Cancer and its treatments
• Family history of blood clots

How can one reduce the risk of developing VTE? Preventive strategies include:

1. Staying active and avoiding prolonged periods of immobility
2. Maintaining a healthy weight
3. Quitting smoking
4. Wearing compression stockings when advised by a healthcare provider
5. Taking prescribed anticoagulants as directed, especially after surgery or during periods of increased risk

Long-term Management of Venous Thromboembolism

After initial treatment, long-term management of VTE is essential to prevent recurrence and manage potential complications. Key aspects of long-term care include:

Duration of Anticoagulant Therapy

The duration of anticoagulant treatment varies depending on individual factors. For some patients, a 3-6 month course may be sufficient, while others may require indefinite therapy. Regular follow-ups with healthcare providers are crucial to assess the ongoing need for anticoagulation.

Monitoring for Post-thrombotic Syndrome

Post-thrombotic syndrome (PTS) is a common long-term complication of DVT, characterized by chronic leg pain, swelling, and skin changes. Early recognition and management of PTS symptoms can significantly improve quality of life.

Lifestyle Modifications

Adopting a healthy lifestyle is essential for long-term VTE management. This includes maintaining regular physical activity, achieving and maintaining a healthy weight, and avoiding prolonged periods of immobility.

Emerging Treatments and Research in Venous Thromboembolism

The field of VTE management is continuously evolving, with ongoing research focusing on improving diagnosis, treatment, and prevention strategies. Some areas of active investigation include:

Novel Oral Anticoagulants

Researchers are developing new oral anticoagulants with improved safety profiles and more convenient dosing regimens. These advancements aim to enhance patient adherence and reduce the risk of bleeding complications.

Personalized Medicine Approaches

Genetic testing and biomarker analysis are being explored to tailor VTE treatment to individual patients. This personalized approach may help optimize anticoagulation therapy and improve outcomes.

Advanced Imaging Techniques

Ongoing research is focused on developing more accurate and less invasive imaging methods for diagnosing VTE. These advancements may lead to earlier detection and more precise treatment planning.

As research progresses, it’s important for patients and healthcare providers to stay informed about the latest developments in VTE management. Regular consultation with medical professionals ensures that patients receive the most up-to-date and effective care for their condition.

Diagnosis and Treatment of Venous Thromboembolism

Diagnosis

View the full infographic

There are other conditions with signs and symptoms similar to those of DVT and PE.  For example, muscle injury, cellulitis (a bacterial skin infection), and inflammation (swelling) of veins that are just under the skin can mimic the signs and symptoms of DVT.  It is important to know that heart attack and pneumonia can have signs and symptoms similar to those of PE.  Therefore, special tests that can look for clots in the veins or in the lungs (imaging tests) are needed to diagnose DVT or PE.

DVT

• Duplex ultrasonography is an imaging test that uses sound waves to look at the flow of blood in the veins. It can detect blockages or blood clots in the deep veins.  It is the standard imaging test to diagnose DVT.
• A D-dimer blood test measures a substance in the blood that is released when a clot breaks up. If the D-dimer test is negative, it means that the patient probably does not have a blood clot.
• Contrast venography is a special type of X-ray where contrast material (dye) is injected into a large vein in the foot or ankle so that the doctor can see the deep veins in the leg and hip.  It is the most accurate test for diagnosing blood clots but it is an invasive procedure, which means it is a medical test that requires doctors to use instruments to enter the body.  Therefore this test has been largely replaced by duplex ultrasonography, and it is used only in certain patients.
• Magnetic resonance imaging (MRI)—a test that uses radio waves and a magnetic field to provide images of the body—and computed tomography (CT) scan—a special x-ray test—are imaging tests that help doctors diagnose and treat a variety of medical conditions.  These tests can provide images of veins and clots, but they are not generally used to diagnose DVT.

PE

• Computed tomographic pulmonary angiography (CTPA) is a special type of X-ray test that includes injection of contrast material (dye) into a vein. This test  can provide images of the blood vessels in the lungs.  It is the standard imaging test to diagnose PE.
• Ventilation-perfusion (V/Q) scan is a specialized test that uses a radioactive substance to show the parts of the lungs that are getting oxygen (ventilation scan) and getting blood flow  (perfusion scan) to see if there are portions of the lungs with differences between ventilation and perfusion. For example, if there are clots in some of the blood vessels in the lungs, the V/Q scan might show normal amounts of oxygen, but low blood flow to the portions of the lungs served by the clotted blood vessels. This test is used when CTPA is not available or when the CPTA test should not be done because it might be harmful to the particular patient.
• Pulmonary angiography is a special type of X-ray test that requires insertion of a large catheter (a long, thin hollow tube) into a large vein (usually in the groin) and into the arteries within the lung, followed by injection of contrast material (dye) through the catheter.   It provides images of the blood vessels in the lung and it is the most accurate test to diagnose PE.  However, it is an invasive test so it is used only in certain patients.
• Magnetic resonance imaging (MRI) uses radio waves and a magnetic field to provide images of the lung, but this test is usually reserved for certain patients, such as for pregnant women or in patients where the use of contrast material could be harmful.

Treatment

Anticoagulants

• Anticoagulants (commonly referred to as “blood thinners”) are the medications most commonly used to treat DVT or PE. Although called blood thinners, these medications do not actually thin the blood. They reduce the ability of the blood to clot, preventing the clot from becoming larger while the body slowly reabsorbs it, and reducing the risk of further clots developing.
• The most frequently used injectable anticoagulants are
  • Unfractionated heparin (injected into a vein),
  • Low molecular weight heparin (LMWH) (injected under the skin), and
  • Fondaparinux (injected under the skin).
• Anticoagulants that are taken orally (swallowed) include
  • Warfarin,
  • Dabigatran,
  • Rivaroxaban,
  • Apixaban, and
  • Edoxaban.
• All of the anticoagulants can cause bleeding, so people taking them have to be monitored to prevent unusual bleeding.

Thrombolytics

• Thrombolytics (commonly referred to as “clot busters”) work by dissolving the clot. They have a higher risk of causing bleeding compared to the anticoagulants, so they are reserved for severe cases.

Inferior vena cava filter

• When anticoagulants cannot be used or don’t work well enough, a filter can be inserted inside the inferior vena cava (a large vein that brings blood back to the heart) to capture or trap an embolus (a clot that is moving through the vein) before it reaches the lungs.

Thrombectomy/Embolectomy

In rare cases, a surgical procedure to remove the clot may be necessary.   Thrombectomy involves removal of the clot in a patient with DVT.   Embolectomy involves removal of the blockage in the lungs caused by the clot in a patient with PE.

How is DVT diagnosed? – Blood Clots

In the diagnosis of DVT, the physician considers the patient’s specific risk factors, the patient’s symptoms, the physical examination, other possible explanations for the symptoms, and the results of objective tests, such as some method of imaging or seeing the clot.

Duplex Ultrasound

The first diagnostic method that is usually performed to image or see the clot is ultrasound—specifically, duplex ultrasound. “Duplex” refers to the two parts of the process:

Part One of the Duplex Ultrasound Process:  In the first part of the process, brightness modulation ultrasound (also known as B-mode ultrasound) is used to obtain an image or picture. The ultrasound machine creates high-energy sound waves (ultrasound) that are bounced off internal tissues and make echoes. The patterns of these echoes form an image, which is then shown on the screen of the machine. While imaging the deep veins of the leg, the sonographer (the person who operates the ultrasound machine) tries to collapse or compress the veins. If a vein cannot be compressed because a clot prevents the vein from collapsing, a DVT diagnosis is made. The ability to completely flatten a vein with compression is the most useful way to be certain that a clot is not present.

Part Two of the Duplex Ultrasound Process: In the second part of the duplex ultrasound process, Doppler ultrasound is used to detect abnormalities of blood flow. Sound waves are bounced off the blood within a vein. Flowing blood changes the sound waves by the “Doppler effect.” The ultrasound machine can detect these changes and determine whether blood within a vein is flowing normally. Absence of blood flow confirms the diagnosis of DVT.

Duplex ultrasound successfully identifies 95 percent of deep vein thromboses that occur in the large veins above the knee.

The ability of duplex ultrasound to detect DVT in the large veins above the knee is so good that when the test is positive, no further testing is necessary and treatment may be started. Conversely, if the test is negative, the chance that there is a DVT is so small that treatment may safely be withheld.

This technique is not as good at detecting DVT that occurs below the knee or in the calf veins, however. Duplex ultrasound successfully identifies only 60 to 70 percent of calf vein thromboses. Even when such a diagnosis is made, it is correct only 60 to 70 percent of the time. While calf vein thromboses account for 20 percent of all DVT cases, only one in five these thromboses ever grows in the first week or two after it is initially suspected. Also, calf vein thromboses are less likely to break free and travel to the lung or “embolize.” Therefore, if the ultrasound is negative, even though a DVT may be present in a calf vein, treatment may be withheld and the ultrasound repeated in five to seven days if the symptoms persist. Calf vein thrombosis may be treated like superficial thrombophlebitis. Most physicians prescribe anticoagulants in such cases, however, because a DVT in a calf vein can lead to a larger, more proximal DVT that can break off and migrate to the lung.

Duplex Ultrasound in Recurrent DVT

Abnormalities of the veins are common after DVT, making it difficult to diagnose a recurrent clot. For instance, half of the time the results of the duplex ultrasound remain abnormal one year after the first episode of DVT. Consequently, if duplex ultrasound is being performed to determine whether a new clot has developed, lack of compression or absence of blood flow does not prove the existence of a new clot unless a new segment of the vein or a different vein is involved.

Venography and Magnetic Resonance Imaging

If the ultrasound is negative, yet the patient’s symptoms are severe or a DVT is strongly suspected, the next step is either a venogram (venography) or magnetic resonance imaging  (MRI).   Sometimes the ultrasound is negative because there is a clot in a vein in the pelvis, hidden from the ultrasound. Although isolated pelvic vein thrombosis is uncommon, it can occur in women who are pregnant or who have recently delivered a baby, in people who have had pelvic cancer, or in people who have had recent pelvic surgery.

Until recently, venography using x-rays was used to diagnose DVT. During venography, contrast dye (usually an iodine dye), which helps blood vessels show up clearly on x-ray, was injected into a vein in the foot. A series of x-rays of the veins was then taken, looking for blockages. Today, the use of x-ray venography has been almost entirely replaced by the use of ultrasound and magnetic resonance (MR) venography, because x-ray venography is “invasive” and can be painful. The MR machine uses pulses of radio-frequency waves to cause hydrogen atoms to line up within tissues. When the pulse stops, the hydrogen atoms return to their natural state. In the process, they give off a signal that the machine converts into an image. Different tissues give off different signals. Because clots give off different signals than flowing blood, MR can be used to detect a thrombosis.

MR venography does a better job of imaging the veins in the pelvis, abdomen, and chest than ultrasound does. Because it does not require compression, this technology can be used to detect clots in limbs inside of plaster casts. Overall, MR may be superior to ultrasound, but it is a much more involved test and costs much more than ultrasound.

D-Dimer Test

After a blood clot starts to form, another series of reactions normally begins to dissolve (that is, lyse) the clot. Fibrin, which forms the mesh that holds the platelets firmly in place within a clot, is a solid that is formed from fibrinogen, a specialized protein (clotting factor) found in blood. (See Question 3.) These fibrinogen molecules are strung together end-to-end and cross-linked within fibrin.

During the lysis process, fibrin is broken down or degraded by an enzyme called plasmin. Plasmin cuts the strands of fibrin on either side of what were the ends of the fibrinogen molecules. The ends are called “D” units. A dimer is a pair, so the D-dimer is a fragment of cross-linked fibrin that consists of two “D” units. D-dimers can be present in a variety of conditions, including the formation of a blood clot. While the presence of D-dimers does not guarantee that a blood clot is present, it is a clue that the clotting process has begun. It D-dimers are absent, however, it is very unlikely that a blood clot has begun to form. For that reason, a blood test for D-dimers is often performed to ensure that a blood clot is absent.

Deep vein thrombosis of the lower extremities Causes, symptoms, diagnosis and treatment of deep vein thrombosis

Content:

1. Deep vein thrombosis (DVT) – what is it?
2. Deep vein thrombosis is dangerous!
3. Deep vein thrombosis in varicose veins
4. Deep vein thrombosis – causes of DVT
5. Risk groups for deep vein thrombosis
6. What are the symptoms of deep vein thrombosis
7. Deep vein thrombosis – diagnostics
8. Surgical treatments for deep vein thrombosis
9. Deep vein thrombosis – treatment in Moscow
10. Deep vein thrombosis – conservative treatment
11. Deep vein thrombosis medical treatment
12. Diet for deep vein thrombosis of the lower extremities
13. Deep vein thrombosis – home treatment
14. Prophylaxis of deep vein thrombosis of the lower extremities
15. Deep vein thrombosis – testimonials from our patients
16. Frequently asked questions of our patients on the Internet about deep vein thrombosis

Deep vein thrombosis (DVT) – what is it?

Deep vein thrombosis is a disease in which blood clots (thrombi) form in the lumen of deep veins. The lower extremities are most commonly affected.

Mechanism of development of deep vein thrombosis

When the disease develops, the health of deep vessels is at risk. If timely treatment is not prescribed, there can be serious consequences.

Deep vein thrombosis is dangerous!

This is how thrombosis of the glomerular veins of the lower extremities looks like

Due to the formation of blood clots, the normal blood flow is disturbed, and this leads to blockage of blood vessels. With such disorders, tissue necrosis can occur in some areas of the body. In the worst case, the formed blood clots break off and enter the heart or lung. In such cases, due to thromboembolism of the lung artery, the person dies.

Deep vein thrombosis – wikipedia says…

DVT is considered a pathological condition characterized by the formation of blood clots in the deep vein cavity. This disease occurs in 10-20% of the total population. 3-15% of people who do not receive proper treatment die from pulmonary embolism.

Deep vein thrombosis in varicose veins

Deep vein thrombosis is a very common complication of varicose veins.

Deep vein thrombosis is often a complication of varicose veins

The severity of the disease will depend on the location of the thrombus and its size. If there is no complete blockage of the vessel, there may be no symptoms of the disease.

Deep vein thrombosis – causes of DVT

Deep vein thrombosis most often occurs with a combination of several factors:

• in violation of blood clotting;
• when slowing blood flow;
• in case of damage to the vascular walls.

There are risk factors that provoke the occurrence of thrombosis, these are:

• advanced age;
• smoking;
• overweight;
• use of certain drugs, including oral contraceptives;
• pregnancy and childbirth;
• sedentary lifestyle;
• some operations;
• injuries that damage blood vessels.

Risk groups for deep vein thrombosis

The risk group includes people who:

• varicose vein transformation;
• sedentary lifestyle;
• operations were performed on the extremities, as well as in the pelvis and abdomen;
• had leg bone fractures;
• there are tumors in the abdominal cavity, pelvis and retroperitoneal space;
• dyshormonal condition of the endocrine or reproductive system;
• positional compression syndrome.

What are the symptoms of deep vein thrombosis

As a rule, symptoms do not appear immediately, only if the thrombus grows. If a clot breaks off, shortness of breath, chest pain, and hemoptysis may occur.

The development of the disease can be recognized by the following symptoms:

• swelling of the legs;
• bluish skin tone;
• pain when walking.

The main symptom of deep vein thrombosis is leg pain!

If you have these symptoms, you most likely have deep vein thrombosis. Stages or variants of the course determine the method of treatment.

Deep vein thrombosis – diagnosis

The main method for diagnosing deep vein thrombosis today is ultrasound duplex scanning. With ultrasound, you can determine the location of the thrombus, its size, condition (it is attached to the walls of the vein or dangles in the lumen – floats).

Doctor Malakhov A.M. conducts ultrasound diagnostics of deep veins of the lower extremities

Also, phlebography and radionuclide scanning are prescribed to assess venous blood flow. The state of microcirculation is assessed based on the data of rheovasography.

Surgical treatment of deep vein thrombosis

If a patient has a severe form of thrombosis of the lower extremities, the most effective method of treatment is surgery – thrombolysis. A timely operation makes it possible to restore full blood flow, if the diagnosis is deep vein thrombosis. Only a timely intervention can completely cure the patient from this serious condition. Thrombolysis is performed only in stationary conditions and by very experienced endovascular surgeons. Treatment after surgery is also aimed at the same goal – the resorption of blood clots.

In addition to thrombolysis, there are two more surgical methods for the treatment of deep vein thrombosis – this is thrombectomy with angioplasty and placement of a cava filter for blood clots.

Surgical methods of treatment of deep vein thrombosis

Deep vein thrombosis – treatment in Moscow

Modern Moscow medicine offers several methods of treating deep vein thrombosis, the use of which depends on the severity of the disease. In the early stages, thrombolytic drugs can be dispensed with if you have deep vein thrombosis. Treatment (Moscow is a city where there are world luminaries in phlebology) must be very qualified. In the later stages, such therapy is dangerous due to the possible separation of a blood clot and the occurrence of thromboembolism of the pulmonary artery. If severe circulatory disorders and deep vein thrombosis are observed, treatment is surgery (thrombectomy).

Deep vein thrombosis – conservative treatment

With conservative treatment, you can only stop or slow down the progression of the disease. Such therapy can also be prescribed in complex treatment.

Principles of conservative therapy:

• compression therapy (elastic compression) – the result of such an impact is the exclusion of the mechanisms of progress of varicose veins, without such therapy, conservative treatment is impossible;
• the required level of compression is achieved through the use of special knitwear (special medical device), in this case it is important to choose the right size of compression stockings;
• compression hosiery is able to relieve swelling, pain and fatigue of the lower extremities;
• the desired result is achieved with the constant application of elastic compression.

Deep vein thrombosis medical treatment

It implies a course of treatment with anticoagulants (drugs that do not allow blood to clot). The average duration of such a course is at least 3 months, and sometimes longer. A combination of drugs that differ in the mechanism of action is envisaged. An important step in the medical treatment of DVT is the selection of blood-thinning drugs. To prevent complications from the gastrointestinal tract, some drugs are administered parenterally.

Pharmacotherapy is often done on an outpatient basis. In severe forms of the disease, patients who have suffered pulmonary embolism or vena cava thrombosis are annually hospitalized in a therapeutic or cardiology department for 2-3 weeks, where infusion hemorheological and cardiotonic therapy is performed.

Diet for deep vein thrombosis of the lower extremities

For vein thrombosis, a diet should be followed, excluding foods containing significant amounts of vitamin K and C from the diet. Moderate fluid intake is also recommended.

Eat foods that thin the blood, such as garlic, peppers and artichokes.

Deep vein thrombosis – treatment at home

Today, along with traditional methods of treating the disease, traditional medicine is practiced if deep vein thrombosis is diagnosed. Treatment with folk remedies is used as an addition to the main treatment.

The first thing to do is thin the blood. If you have deep vein thrombosis, traditional treatment includes the following foods:

• onion and garlic;
• sunflower seeds;
• cocoa;
• beets;
• apple cider vinegar;
• tomatoes or tomato juice;
• hercules;
• oatmeal;
• cranberries;
• oatmeal;
• lemon;
• cherries;
• viburnum.

Blood thinning must be handled with care so as not to provoke bleeding. It is not recommended to consume fatty and meat products if deep vein thrombosis is present. Photos, results of improper treatment are available on the Internet.

One tablespoon of a mixture prepared from crushed garlic, two tablespoons of unrefined vegetable oil and one tablespoon of honey can be eaten daily.

Prevention of deep vein thrombosis of the lower extremities

Prevention of the disease is primarily aimed at eliminating the causes that cause the development of vascular diseases. Thus, you need to get rid of bad habits, reduce body weight, treat diabetes, lower blood cholesterol levels and move more. So it will be possible to defeat deep vein thrombosis of the lower extremities (diet, photo, results should be an incentive!).

Deep vein thrombosis – feedback from our patients.

Review of our patient about the treatment of deep vein thrombosis in the center “MIFTS”

Anita, 38 years old, Moscow.

I want to thank the staff of the clinic for their professionalism. With their help, I started to trust traditional medicine again. Before I went to the clinic, I had repeatedly undergone various medical procedures for deep vein thrombosis in my legs. At first, I had varicose veins with a complication, in which I had an operation to “suture the veins”. As a result, I practically became disabled. On the advice of my friends, I turned to the doctors of the MIFTs clinic, who returned me to a full life. It’s good that everything went without surgery. Anita, 38 years old, Moscow.

Patient’s feedback on the diagnosis of deep vein thrombosis in our center

Andrey, 40 years old, Krasnogorsk.

Due to frequent stressful situations and bad habits, I have problems with my legs, or rather, circulatory disorders. The legs often swelled, turned blue and sometimes hurt when walking. On the Internet, I accidentally saw an article about vein thrombosis, while the symptoms described coincided with my feelings. I was just recently advised by the phlebology clinic, and I decided to go for a consultation. Doctor Malakhov A.M. diagnosed with acute deep vein thrombosis. At first I was reassured and told that in this case, one cannot do without surgical intervention. Since there was no other way out, I agreed, and did not regret it. The operation in the vascular department of the city hospital, where I was urgently hospitalized, to remove the blood clot was successful and without complications. Now nothing threatens my life, thanks to the doctors of the “MIFTS” clinic for their professionalism and “human” attitude towards patients! Andrey, 40 years old, Moscow.

Frequently asked questions of our patients on the Internet about deep vein thrombosis

How to understand that there are blood clots in the veins?

Only a specialist, phlebologist or vascular surgeon can reliably understand that there are blood clots in the veins. And even a specialized specialist will need instrumental support, ultrasound examination of blood vessels. You can assume that you have blood clots in your veins by the following signs:

• Edema.
• Cyanosis of the skin.
• Soreness, swelling of tissues, redness of the skin along the veins.

If there are blood clots in the veins, how to recognize them, symptoms and treatment?

Blood clots in veins can be identified using duplex ultrasound. The following symptoms indicate the presence of blood clots in the veins: swelling, pain, discoloration of the limb. The best option for diagnosis, as well as subsequent treatment, is to contact a good phlebological center.

How to recognize a blood clot on the leg?

In order to recognize a blood clot on the leg, it is necessary to seek professional medical help. As an option, do an ultrasound examination of the vessels of the lower limb. The best solution would be to consult a narrow specialist, a phlebologist.

How to identify blood clots in the legs?

From the point of view of modern diagnostics, the best way to determine blood clots in the legs is an ultrasound examination of the vessels of the lower extremities.

Thrombus in a vein, how does it form?

A thrombus in a vein is formed as a result of a complex chain of biochemical reactions, during which a network of insoluble fibrin molecules is formed from fibrinogen molecules. In the latter, blood cells are fixed, creating a dense intravascular structure, which is a thrombus.

How to identify a blood clot?

Thrombus can be identified by various methods, such as computed tomography, magnetic resonance imaging, and good ultrasound. The latter technique is more optimal in terms of price-quality ratio and is the gold standard for diagnosing thrombosis.

How to prevent the formation of blood clots in the vessels?

You can prevent the formation of blood clots in the vessels if you are examined by a phlebologist in a timely manner, follow the doctor’s recommendations, eliminate varicose veins, if they are detected.

what is it, prevention, symptoms, signs of thrombosis

Thrombosis – complete or partial blockage of the vessel lumen by a parietal or mobile thrombus. A thrombus is a dense blood clot that appears as a result of a change in its fluidity. Normally, thrombus formation is a protective mechanism. Damage to the vascular wall entails a slowdown in blood flow, the accumulation of platelets around the damage. The thrombus literally “darns” the vessel wall.

Classical causes of thrombus formation are described by Vihrov’s triad: damage to the vascular wall, slowing of blood flow, and changes in blood properties [3]. Some thrombi (they are called emboli) are able to move to narrower sections of the vessel, which clog completely or partially. Every year, about 25 million people die from thrombosis, and even more face trophic disorders caused by blood clots [3].

Types of vascular thrombosis

Thrombosis of the lower extremities is the most common, but the greatest danger is pulmonary embolism – PE – and disseminated intravascular coagulation syndrome – DIC.

Arterial thrombosis develops when its lumen is blocked by a thrombus or embolus. Clinical signs are determined by the site where such a blockage occurred, an organ or tissue that is poorly supplied with blood or not supplied with it at all. If the blockage with impaired patency of the vessel occurs slowly, “spare”, collateral, vessels open, which alleviates the clinical symptoms of arterial thrombosis [3]. Arterial thrombosis occurs more often in middle-aged and elderly men [7].

Venous thrombosis varies depending on the location of the lesion for deep or superficial vein thrombosis and pulmonary embolism. Among all cardiovascular pathologies, venous thrombosis ranks third in frequency of occurrence, second only to coronary artery disease and atherosclerosis. The third place in the structure of causes of death is PE. Starting from the age of 40, the risk of developing venous thrombosis doubles every 10 years [5].

Two types of damage to the veins of the lower extremities are described: phlebothrombosis (primary thrombosis, the thrombus is not firmly fixed) and thrombophlebitis (secondary thrombosis against the background of inflammation of the vessel wall, the thrombus is firmly fixed) [6]. Thrombophlebitis is more often associated with superficial vein thrombosis [2]. The larger the vein affected by thrombosis, the brighter its clinical manifestations. The surrounding tissues are compressed by stasis of blood, since the blood stays at the site of occlusion, but does not move towards the heart. Venous clots tend to break off and spread with the blood stream (thromboemboli). When they enter the vital organs, life-threatening conditions develop [3].

Causes of thrombosis

Common causes of thrombosis formation are described above. Arterial thrombosis begins with the formation of atheroma – an atherosclerotic plaque. Platelets accumulate around it. The plaque itself may be harmless, but when its surface is injured, dense blood clots form at the site of the tear. This process is called “atherothrombosis” [3, 7]. Venous thromboses are formed when the rheological properties of blood change or as a reaction to inflammation of the vascular wall [5].

Thrombosis risk factors

Internal:

• arterial hypertension [7];
• pregnancy, childbirth, postpartum [3];
• biochemical changes in blood [2,3,5,7];
• vasculitis [2];
• age over 40 [5];
• congenital thrombophilia, thrombosis, varicose veins of the lower extremities [3,5];
• congestive heart failure [5, 6];
• malignant neoplasms, radiotherapy and chemotherapy [3];
• strokes [3, 6];
• myeloproliferation [2, 5, 7];
• nephrotic syndrome and renal failure [5, 6, 7];
• obesity (BMI over 30) [3];
• myocardial infarction [6];
• diabetes mellitus [6, 7];
• systemic lupus erythematosus [2];
• chronic pulmonary diseases [3];
• enterocolitis [5].

External:

• heroin addiction [2];
• hormone therapy [3,5];
• dehydration with vomiting, diarrhea, increased sweating, direct lack of fluid [6];
• immobilization [3];
• trips by plane, bus or seated car [3];
• infectious diseases, including COVID-19 [1, 3, 5, 9];
• catheterization of central and peripheral veins [2, 5];
• smoking [6, 7];
• sedentary lifestyle [3];
• operations [3];
• fractures of large bones, other injuries [3];
• taking oral contraceptives [5];
• taking Diazepam, Amiodarone, Vancomycin [2];
• sclerotherapy and thermal ablation [2];
• condition after joint replacement [3];
• holding an uncomfortable posture [3].

Thrombosis Clinic

Symptoms of thrombosis may be general, regardless of location, or specific. Common symptoms include pain on movement and at rest, limited mobility, and reduced function of the affected organ or tissue.

Symptoms of impaired arterial patency (acute thrombosis, or gradual impairment of vessel patency):

• BP asymmetry when measured on both arms [7];
• pale skin turning into cyanosis [7];
• pain at rest at night [7];
• pain on movement in the thigh, buttock, leg, foot, shooting or aching [7];
• sleep disorders [7];
• numbness, cold extremity [7];
• absence of peripheral pulsation [7];
• necrosis (necrosis) of affected tissues, trophic ulcers, gangrene [7];
• intermittent claudication [7].

Symptoms of venous thrombosis:

• pain [6];
• edema, soft and asymmetric [6];
• blue skin (skin cyanosis) [6];
• fever of the skin of the extremities [6];
• increased sensitivity and thickening in the projection of the superficial veins [2];
• post-inflammatory hyperpigmentation [2];
• dilated saphenous veins [6];
• erythema [2].

Sometimes the only symptom of venous thrombosis is PE [6].

Thrombosis diagnostics

Primary diagnosis is based on a detailed history and anthropometry (calf or thigh circumference). Wells scales are used for the diagnosis of acute thrombosis and the diagnosis of PE [8,9].

Imaging includes vein compression or duplex scanning, vein compression Doppler, impedance plethysmography, pulmonoangiography, radiopaque or MRI phlebography [6,9], CT and MRI angiography [7,9].

For the diagnosis of arterial thrombosis, physical tests (6-minute walk test, treadmill test), determination of pulsation of superficially located arteries (arteries of the dorsal foot), duplex scanning of the arteries of the extremities, angiography (X-ray of a vessel filled with a radiopaque substance) and measurement of transcutaneous tension are used oxygen [7].

Thrombosis tests

A significant role in the timely diagnosis of thrombosis is played by laboratory parameters. Thus, guidelines for the management of patients with a new coronavirus infection provide for the stratification of the risk of coagulopathy in patients with COVID-19based on simple laboratory tests: D-dimer, prothrombin time, platelet count, fibrinogen level [1,9].

CBC reveals inflammation. It also determines the level of platelets, that is, the very substrate of thrombosis.

In addition, an increased level of C-reactive protein indicates the level of inflammation in the blood and the risk of thrombosis.

Biochemical analysis primarily shows the level of blood glucose. It can be used to judge the presence of diabetes, one of the most serious risk factors for thrombosis.

Also, biochemical analysis is able to determine the level of protein C, which also characterizes the severity of the risk of thrombosis.

Elevated blood homocysteine ​​is also a proven risk of thrombosis leading to miscarriage and cardiovascular events (heart attacks and strokes).

D-dimer is a laboratory marker of fibrin formation [8]. It also indicates the presence of inflammation, like C-reactive protein. D-dimer levels are a benchmark for COVID-19and its complications, including those associated with thrombosis.

It is possible to take tests according to the complex program “Thrombosis”, which includes the determination of the levels of Antithrombin-III, D-dimer and genetic factors of cardiac diseases and the level of platelets. This program allows you to determine the fact of an accomplished thrombosis somewhere in the body, as well as determine the genetic predisposition to it. Such a program, as well as other analyzes, is offered by the CITILAB network of clinics.

Additional determination of the level of homocysteine, C-reactive protein will help determine the biochemical risk of thrombosis.

Treatment and prevention of thrombosis

Treatment of thrombosis includes anticoagulant and antiplatelet therapy, thrombolytic therapy, installation of an inferior vena cava cava filter, and surgical removal of a thrombus [5]. It is necessary to keep in mind the complications of anticoagulant therapy: major bleeding, heparin-induced thrombocytopenia and warfarin-induced skin necrosis [5]. NSAIDs are used to reduce the risk of continued thrombus formation [2]. For the purpose of secondary prevention, small doses of heparin are prescribed.

Non-drug methods of treatment are also prescribed – elastic bandaging, compression stockings, local hypothermia and exercise therapy [2, 4].

Thrombosis prophylaxis includes a range of interventions used in situations of increased risk of thrombosis.

Primary prevention of atherothrombosis:

• systematic physical activity in the form of walking or morning exercises;
• BP control, maintenance of working blood pressure below 140/90 mmHg;
• control of blood sugar levels (less than 6 mmol/l), early detection and treatment of diabetes mellitus;
• weight loss, body mass index less than 25 kg per m2;
• restricted cholesterol and high-density fat diet (total cholesterol less than 5 mmol/l), fruits and vegetables;
• smoking cessation [3,7].

Primary prevention of venous thrombosis:

• compression stockings;
• bandaging with elastic bandages;
• drink plenty of fluids, especially after surgery;
• regular exercise, walking, especially when traveling;
• prohibition of alcohol and sleeping pills in large doses;
• prohibition of the use of squeezing shoes and clothing [2,5,6].

Sometimes, for periods of high risk, anticoagulants are prescribed a few days before the flight. Aspirin to take in such cases does not make sense [5].

References

1. Agreed position of experts of the Eurasian Association of Therapists on some new mechanisms of COVID-19 pathogenesis: focus on hemostasis, blood transfusion issues and the blood gas transport system / G.P. Arutyunov, N.A. Koziolova, E.I. Tarlovskaya, A.G. Arutyunov, N.Yu Grigorieva and others// Cardiology. 2020;60(6). DOI: 10.18087/cardio.2020.5.n1132.
2. Thrombophlebitis (thrombosis of superficial veins): modern standards for diagnosis and treatment / V. Yu. Bogachev, B.V. Boldin, O.V. Jenina, V.N. Lobanov // Hospital-replacing technologies: Ambulatory surgery. 2016.- 3-4 (63-64) – P.16-23.
3. Modern problems of thrombosis of arteries and veins / I.N. Bokarev, L.V. Popova//Practical medicine, 2014. – No. 6 (82) -С13-17.
4. Treatment of thrombophlebitis. Current recommendations and clinical practice / P.F. Kravtsov, K.V. Mazaishvili, S.M. Markin, H.M. Kurginyan // Thrombosis, hemostasis and rheology, 2020 No. 2 – C 68-72.
5. Venous thrombosis: modern treatment / P.S. Laguta // Atherothrombosis, 2015 – No. 2- P. 7-16.
6. Deep vein thrombosis of the lower extremities / A.K. Lebedev, O.Yu. Kuznetsova // Russian family doctor, 2015.
7. National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities, Association of Cardiovascular Surgeons of Russia, Russian Society of Angiologists and Vascular Surgeons, Russian Society of Surgeons, Russian Society of Cardiology, Russian Association of Endocrinologists, M, 2019.