Deep Vein Thrombosis (DVT) – Symptoms, Causes & Treatment

May 9, 2023

Deep Vein Thrombosis or DVT is a blood clot in a vein. It is most common in the calf muscle area, particularly following surgery and long-haul flights. Do not confuse this with a calf strain. Incorrect treatment can cause life-threatening complications.

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DVT symptoms

Deep vein thrombosis symptoms consist of:

• Constant pain, usually in the calf muscle at the back of the lower leg.
• Tenderness deep within the muscle.
• You may have swelling in the calf muscle area.
• Skin temperature may seem hot to the touch.
• Sometimes a red area is visible on the skin.

Pain may be reproduced when passively stretching the calf muscle (you relax the muscle while someone else moves your foot to stretch it.

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Diagnosis

Wells’ clinical prediction rule is believed to be the best test for the diagnosis of deep vein thrombosis². It is a checklist of risk factors thought to increase risk. If the patient has more than one out of a potential nine then a DVT is likely.

What is Deep vein thrombosis?

Deep Vein Thrombosis (DVT) is a blood clot in a vein. It is most common in the calf muscle area, particularly following surgery, or in those who have had long-haul flights. This is because the patient has been sitting still for long periods, combined with a change in air pressure. It may also develop as a complication of arthroscopic surgery¹.

DVT is relatively common, especially in the following:

• Overweight people
• Those over the age of 50
• People who have poor circulation.

It is not something you would expect in young fit athletes. However, the condition is potentially fatal if not recognised. This is because if the blood clot breaks loose it may make its way up the circulatory system to the heart, lungs, or brain. As a result, potentially causes a heart attack, pulmonary embolism, or stroke.

If a massage therapist misses this or misdiagnoses a DVT as a calf strain and applies deep tissue massage to the area then this could work the clot free and cause serious harm or worse.

Treatment

If you suspect a DVT then seek medical attention immediately. See a doctor who can give a professional opinion and refer you for further investigations. A scan will confirm the diagnosis.

Treatment usually involves daily injections of an anticoagulant known as Heparin for up to a week.

This is followed by a second anticoagulant medication called Warfarin, taken in pill form, on a daily basis for up to 6 months.

Your doctor will do regular blood tests to ensure the medication dose is correct. Too much Warfarin increases the risk of bleeding and too little increases the risk of the clot growing.

Important! – Warfarin should not be used in patients who are pregnant as it can cause birth defects.

References

1. Jaureguito JW, Greenwald AE, Wilcox JF et al. The incidence of deep venous thrombosis after arthroscopic knee surgery. Am J Sports Med 1999;27(6):707–10.
2. Wells PS, Hirsh J, Anderson DR et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet, 1995;345(8961):1326-30.

Travelers’ Thrombosis – Traveler Summary

Key Points

• Travelers’ thrombosis begins with blot clots in the leg veins (deep venous thrombosis; DVT) that occur in any setting where a person is immobilized for prolonged periods of time, whether in a car, train, bus, or airplane. A DVT can break loose and travel to the lungs, causing a pulmonary embolus (PE).
• Overall risk is extremely low in those without risk factors, even on long trips; however, important risk factors like underlying cancer or a hereditary clotting abnormality may not be known prior to the first DVT. Other risk factors include travel of 4 or more hours, personal or family history of DVT, obesity, pregnancy, smoking, recent surgery or significant trauma, use of oral contraceptives, and age over 50 years. Nonaisle seats may increase risk due to limitation of movement.
• Symptoms of DVT may be silent or present as a deep pain in one calf or thigh (with swelling). PE may also be silent but symptoms may include sharp chest pain, breathlessness, bloody sputum, and cardiac collapse in some cases. DVT or PE may manifest during or shortly after the flight, but often not for several weeks.
• Prevention includes choosing aisle seating, maintaining hydration, walking frequently, wearing loose clothing, exercising the lower extremities, using a foot rest, and avoiding alcohol and sleeping pills. Graded compression stockings (15-30 mm Hg) that fit properly (not binding at the ankle or knee) can also help. Aspirin has not been proven effective for DVT; persons with clotting disorders or prior history of DVT should discuss options with their health care provider.

Introduction

Deep vein thrombosis (DVT; blood clots in the leg veins) may occur in any situation where there is prolonged pooling of blood in the deep veins of the legs or pelvis, such as in bed-bound persons and those who sit for long periods of time in chairs or on long car, train, or airplane journeys. If a clot or a piece of clot becomes detached from the vein (a process known as venous thromboembolism [VTE]), it can travel to the lungs and cause a pulmonary embolus (PE). A large PE can block a major lung blood vessel and can be fatal; overall, PE occurs in about 0.4 per million airline passengers and is fatal in about 2% of cases. The incidence of VTE is related mostly to personal risk factors, but duration of flight, degree of immobility during the flight, and environmental factors in the cabin can increase risk for those already at risk.

Risk Factors

Whether a clot forms depends on the condition of the walls of the veins, blood flow, and factors that prevent or cause the clotting of blood. Blood flow in the legs may be reduced during long flights or any long trip during which the traveler is sitting for long periods of time. For air travel, the risk of thrombosis increases with the length of the flight. Passengers with cumulative flying times of more than 12 hours within the previous 4 weeks and flying more than 4 hours in 1 flight leg are 2 to 3 times more likely to experience DVT than those who do not fly. DVT, VTE, and PE are extremely uncommon in healthy young adults without personal risk factors. Even in those with risk factors, DVT is uncommon on flights of less than 6 hours.

Inactivity during a flight may be as important as distance flown and is more important than the class of travel; sitting in a window seat versus an aisle seat and sleeping during the flight increases risk.

Personal risk factors for DVTs include (the most important ones are listed first):

• Personal or family history of DVT or PE
• Personal or family history of a known blood clotting disorder predisposing one to thrombosis
• Major surgery, significant trauma, or prolonged immobilization (includes limb casts) in the 6 weeks prior to flight
• Cancer within the last 2 years or currently receiving chemotherapy
• Late pregnancy or the first 6 weeks after childbirth
• Estrogen-containing medication taken for oral contraception, female hormone replacement therapy (HRT), or anti-estrogen therapy (Tamoxifen)
• Age greater than 50 years
• Weight (overweight/obese), height (> 1. 9 m [> 6.2 ft ] or < 1.6 m [< 5.2 ft])
• Chronic venous insufficiency or large varicose veins
• Chronic inflammatory disease

Additionally, subtle clotting abnormalities are surprisingly frequent in the overall population, and these people may not know they are at risk until they experience a problem after a long flight.

Symptoms

Most episodes of calf thrombosis are asymptomatic. In up to half of persons with DVT, symptoms may include deep pain in the calf or thigh and/or swelling of the lower leg or whole leg, depending on the location and extent of the thrombosis; the leg may become warm or discolored.

PE is also commonly silent or may occur without features of a preceding DVT. Symptoms correlate with severity. Mild episodes present with breathlessness, sharp chest pain on breathing, and, occasionally, bloody sputum after coughing. Severe episodes (massive embolism) present with collapse, severe breathlessness, and central chest pain.

Symptoms of VTE commonly develop during or immediately after a flight, often while still in the airport. One in 3 cases of VTE triggered by flying occurs during the first week after travel, and the remainder occur within 8 weeks after travel.

Need for Medical Assistance

Travelers who develop leg pain, ache, discomfort, swelling, increased warmth, discoloration, joint pain in 1 or both legs, chest pain, shortness of breath, or difficulty breathing within 8 weeks of a flight should seek immediate medical attention.

Prevention

Travelers who are or may be at risk of DVT (e.g., previous DVT, PE, or other risk factors) should consult with their health care provider before making their travel plans. Individuals who are on warfarin-derived blood thinners (e.g., Coumadin) should have their blood-clotting test results checked prior to travel. Persons on newer oral anticoagulant agents (e.g., Pradaxa, Xarelto) should consult with their treating physician if any clotting issues have occurred in the previous months.

Prevention of venous stasis (blood pooling in the legs) is the most important measure to follow in preventing DVTs. Travelers can help decrease their risk of DVT while traveling by observing the following precautions:

• Wear comfortable, loose-fitting clothing that is not tight at the knees (e.g., socks/stockings with strong elastic tops) or waist (e.g., pantyhose).
• Get up and walk around the cabin hourly, if possible; this is easiest from an aisle seat.
• Stand up and periodically stretch arms and legs. Many airlines now provide video presentations on stretching exercises during long flights.
• While seated, exercise leg and calf muscles frequently by flexing and extending the ankles and knees.
• Avoid crossing legs, which may decrease blood circulation.
• Use a footrest when possible to reduce the pressure on the back of the thighs or calves.
• Get up and walk around at transit stops.
• Drink enough water to maintain a flow of pale lemon-yellow colored urine.
• Avoid excess alcohol because it may cause sleepiness.
• Avoid sleeping pills and sedatives.
• Wear graded compression stockings that fit well and exert 15 to 30 mmHg at the ankle level if any personal risk factors exist; ill-fitting stockings may actually increase the risk of VTE.

Moderate intake of alcohol or coffee is not a risk factor for VTE. One glass of water is enough to counter the diuretic effect of 2 units of alcohol (e.g., a double whiskey).

Graduated compression stockings (made of double layer merino wool) significantly increase blood flow in the calves and confer about 90% protection against DVTs on flights of more than 4 hours. At-risk passengers who wear below-the-knee compression stockings on flights of more than 8 hours are 6 to 20 times less likely to develop VTE than at-risk passengers who do not wear stockings.

Aspirin does not provide a protective effect and may cause undesired gastrointestinal side effects.

Nizhnekamsk Central District Multidisciplinary Hospital

02/17/2020

To patch the damaged area as quickly as possible, this is the task set by the body in case of damage to blood vessels or bleeding, and blood clots – blood clots serve as patches.
The process of formation of blood clots is called thrombosis, but doctors call it more simply – thrombosis. We will talk about him in this issue with the cardiovascular surgeon Ruslan Fadisovich Shakirov.

– Ruslan Fadisovich, in simple terms, what is thrombosis?

Thrombosis is a blockage of blood vessels by blood clots, most often the veins of the lower extremities. Thrombosis of the veins of the lower extremities is divided into superficial and deep vein thrombosis, which is more dangerous.

The main cause of thrombosis of the veins of the lower extremities is stagnation in the blood, for example, during air travel, when a person travels in a car for a long time (more than two hours), non-transportable and bedridden people.

– How can an ordinary person assume that he has a thrombosis?

– These are the patient’s complaints, the main of which is a sharp swelling of the leg against the background of complete health, bursting pains in the calf muscles, with such symptoms a person should definitely consult a doctor. Most often, people wait 5-7 days, but this is a mistake, because deaths occur in the first days after thrombosis.

– What is the cause of blood clots?

– Thrombi is a multifactorial process, with age, risk factors for thrombosis increase, for example, cancer or after a stroke, after surgery on the first day, other categories of people with congenital blood disorders, that is, a person is predisposed to thrombosis from birth, as well as injuries and pregnancy may cause blood clots

– Bad habits can influence the appearance of the disease?

– Smoking does not affect the development of blood clots, but it affects the formation of atherosclerotic plaques in the arteries, which, ultimately, growing to a certain size, can provoke arterial thrombosis. And taking alcohol the very next day can affect the development of thrombosis, especially if you combine a bath and alcohol. A person in a state of intoxication can fall asleep in an uncomfortable position, which can provoke thrombosis of the veins of the lower extremities. In order to protect yourself in the future, you need to know the signs of the disease. Deep vein thrombosis is considered more dangerous. The main complaint in deep vein thrombosis, I repeat, is leg edema against the background of complete health. When thrombosis is closer to the body, then there is swelling of the entire leg to the groin area, if thrombosis is up to the level of the knee, then only the lower leg swells, while it may be insignificant, but there will be bursting pain in the calf muscle. Thrombophlebitis of the superficial veins most often occurs against the background of varicose veins of the lower extremities, the main symptom of which is the appearance along the vein of a cord-like cord of bright red color and hot to the touch. In such cases, you should immediately go to the hospital.

– They say “a blood clot broke off”, what does this concept mean?

– When a “thrombus came off”, then we are talking about thromboembolic complications. And so that the blood clot does not come off, a person needs to come to the hospital on the first day after the appearance of the above signs. The patient cannot feel the thrombus “hanging” or not. To do this, you need to consult a doctor and conduct an ultrasound. People think that blood clots take years to build up. No, they do not accumulate, they appear suddenly and in a healthy state.

– How to determine that a blood clot has broken off?

– The first sign is a sharp feeling of lack of air, if thrombosis of small branches of the pulmonary arteries, then a dry cough begins there and without fever, and if large branches, then up to loss of consciousness and death. And therefore, you just need to see a doctor on time, even without an appointment, on weekdays to a therapist or surgeon, and on holidays or weekends to the emergency room or call an ambulance. Prevention of thrombosis is determined by doctors, the risk group includes people over 60 years of age, bedridden, postoperative, cancer patients, pregnant women and those with thrombophilia. Such patients, for the purpose of prevention, drink drugs and wear compression underwear.

– What are the statistics in the city?

– For a month, on average, 4-5 people with newly diagnosed diagnoses apply, and on average, according to statistics, 60-70 people per 100,000 people under 60 years old, and after this age, the risk of thrombosis increases to 200 people per 100,000 population per year.

– What advice would you give readers?

– In order to reduce the risk of blood clots, you need to move more – walking is always more beneficial than sitting, standing or lying down, and you need to drink more water. If there is a burdened family history of thrombosis and a person at risk, you can wear compression stockings, go swimming, take a contrast shower, but it is better to consult a doctor first.

According to the materials of the newspaper “World Bulletin”, author Lilia Chebysheva.

Thrombosis

Venous thrombosis is a serious disease characterized by the formation of a blood clot, or thrombus, in the lumen of a vein.

A thrombus formed in the lumen of a vein can completely stop the circulation of blood through it.

Breaking away from the wall of a vein, a clot can enter the heart and further into other vessels, which in turn can cause serious complications.

If a blood clot from the heart enters the vessels of the lungs, a pulmonary embolism (blockage of the lumen of the pulmonary artery) will develop, the consequences of which may be sudden death or necrosis of a large part of the lung.

If a blood clot enters the vessels of the brain, a stroke will develop, which can also lead to death or disability.

Symptoms and signs of vein thrombosis may differ depending on the vein in which the thrombus has formed. Depending on the location of the thrombus, there are: deep vein thrombosis of the lower extremities (the most common form of thrombosis), ileofemoral thrombosis (thrombus in the femoral or iliac vein), mesenteric vein thrombosis, portal vein thrombosis, retinal vein thrombosis, etc.

Why does vein thrombosis develop?
There are several main causes of blood clots in the veins:

1. Lack of movement in the legs for more than 3 days (eg after major surgery, in paralyzed people, etc.) significantly increases the risk of blood clots in the deep veins of the legs.

2. Dehydration of the body leads to an increase in blood viscosity and slowing down its movement in the vessels and increases the likelihood of blood clots in the veins. Causes of dehydration can include: reduced fluid intake in hot weather, extensive burns, infectious diseases, etc.

3. Operations on the veins of the legs can provoke the formation of blood clots, however, in most cases they are so small that they resolve themselves without causing serious consequences.

4. Disorders in the blood coagulation system can be congenital (exist from birth) or acquired (against the background of oncological, infectious diseases, etc.)

5. Serious injuries can lead to blood clots in the veins in the injured area.

In order to prevent the development of vein thrombosis, doctors identify the presence of so-called risk factors that contribute to the formation of blood clots. In the presence of several of these risk factors, the patient is prescribed drugs that prevent the development of thrombosis. Here are some risk factors for thrombosis:

1. Age over 75
2. Obesity and overweight
3. Presence of oncological (cancerous) diseases
4. Absence of movement in the legs for more than 3 days, or long flights, car trips, etc.
5. Condition after surgery
6. Past venous thrombosis
7. Major burns and injuries, bone fractures
8. Pregnancy and recent childbirth

9. Sepsis (blood poisoning)

10. Diseases of the cardiovascular system: myocardial infarction, angina pectoris, heart failure, etc.

Symptoms and signs of thrombosis

Thrombi can be located in both deep and superficial veins. If the thrombus is located in the deep veins of the legs, then pain first appears, then swelling of the lower limb. With thrombosis of superficial veins, painful seals and redness of this area appear on the skin.

The most dangerous consequence of thrombosis can be the movement of a thrombus with the blood flow – embolism, which most often settles in the lungs, leading to hemorrhagic pulmonary infarction.

Deep vein thrombosis of the legs can occur with little to no symptoms or subtle signs. Here are some of them:

1. Swelling of the lower third of the leg is the most common symptom of deep vein thrombosis of the lower leg. If thrombosis extends to higher parts of the leg (veins of the thigh and pelvis), then the swelling can capture the entire leg, or both legs. There is pain in the groin area.
2. Pain in the calf muscles is an intermittent symptom of deep vein thrombosis and may be absent in half of the cases. Pain in the calf muscle increases with flexion of the foot in the ankle joint. In the presence of such pain in combination with edema, you should immediately consult a doctor.
3. Increased sensitivity of the skin of the leg.
4. The skin in the area of ​​the clot may be warmer and redder than the surrounding areas.
5. In cases where deep vein thrombosis is asymptomatic, it can only be detected with the development of complications – for example, pulmonary embolism, which is manifested by the sudden onset of shortness of breath, a feeling of lack of air, dizziness, up to loss of consciousness. With the development of these symptoms, you should immediately call an ambulance.

Diagnostics of vein thrombosis

The diagnosis cannot be definitively established on the basis of symptoms of thrombosis alone. This requires an additional examination. In the diagnosis of deep vein thrombosis, the following examination methods are used:

1. Determination of the level of D-dimer in the blood, a special substance whose level remains elevated for a week after the onset of acute venous thrombosis.
2. Ultrasound of the veins allows you to quickly and painlessly detect signs of blockage in the vein. A special type of ultrasound – duplex scanning allows you to see a blood clot in the lumen of a vein.
3. Phlebography (venography) is the most informative method for diagnosing deep vein thrombosis, ileofemoral thrombosis, etc. For phlebography, a special contrast agent is injected into a vein on the dorsum of the foot, which allows you to view the veins during x-rays of the leg.