What are the symptoms of a blood clot in the upper leg. How is deep vein thrombosis diagnosed. What causes DVT and who is at risk. How is deep vein thrombosis treated and prevented. What complications can arise from DVT.

Understanding Deep Vein Thrombosis (DVT): A Potentially Serious Condition

Deep vein thrombosis (DVT) is a medical condition characterized by the formation of a blood clot within a deep vein, typically occurring in the leg. This potentially dangerous condition can lead to severe complications if left untreated. DVT most commonly affects the larger veins that run through the calf and thigh muscles, but it can also develop in the pelvic or abdominal regions.

DVT is often associated with venous thromboembolism (VTE), which encompasses both DVT and pulmonary embolism. Understanding the symptoms, causes, and treatment options for DVT is crucial for early detection and prevention of potentially life-threatening complications.

Identifying the Symptoms of Deep Vein Thrombosis

Recognizing the symptoms of DVT is essential for timely diagnosis and treatment. While some cases may be asymptomatic, common signs of DVT include:

• Pain and swelling in one leg, typically in the calf or thigh
• A heavy ache in the affected area
• Warm skin around the clot
• Redness, particularly at the back of the leg below the knee
• Increased pain when bending the foot upward towards the knee

It’s important to note that DVT usually affects only one leg, although it can occur in both. If you experience these symptoms, especially when accompanied by breathlessness or chest pain, seek immediate medical attention.

When to Seek Urgent Medical Care

Can DVT symptoms indicate a medical emergency? In some cases, yes. If you experience leg pain and swelling along with breathlessness or chest pain, it’s crucial to call emergency services or go to the nearest emergency room immediately. These symptoms may indicate a pulmonary embolism, a serious complication of DVT that requires urgent medical intervention.

The Underlying Causes and Risk Factors of DVT

DVT can affect anyone, but certain factors increase the risk of developing this condition. Understanding these risk factors can help in prevention and early detection.

Who is at Risk for Developing DVT?

The risk of DVT increases with age, becoming more common in individuals over 40. However, several other factors can contribute to the development of blood clots:

• Personal or family history of DVT or pulmonary embolism
• Prolonged periods of inactivity, such as after surgery or during long travels
• Blood vessel damage
• Certain medical conditions that increase blood clotting, including cancer, heart and lung diseases, thrombophilia, and Hughes syndrome
• Pregnancy
• Obesity or being overweight
• Use of hormonal contraceptives or hormone replacement therapy

Understanding these risk factors can help individuals and healthcare providers take appropriate preventive measures and monitor for potential DVT development.

Diagnosing Deep Vein Thrombosis: From Symptoms to Confirmation

Accurate diagnosis of DVT is crucial for proper treatment and prevention of complications. The diagnostic process typically involves a combination of clinical assessment and specialized tests.

The Role of D-dimer Testing in DVT Diagnosis

How does a D-dimer test help in diagnosing DVT? This specialized blood test detects fragments of blood clots that have been broken down in the bloodstream. A higher number of these fragments suggests a higher likelihood of DVT. However, it’s important to note that the D-dimer test isn’t always conclusive, as these fragments can be present in other conditions as well.

While a positive D-dimer test can indicate the presence of a blood clot, further diagnostic procedures are often necessary to confirm DVT. These may include ultrasound scans or venography to visualize the blood clot directly.

Treatment Approaches for Deep Vein Thrombosis

Once diagnosed, prompt treatment of DVT is essential to prevent complications and reduce symptoms. The primary goals of DVT treatment are to stop the blood clot from growing, prevent it from breaking loose and causing a pulmonary embolism, and reduce the risk of recurrence.

Anticoagulation Therapy: The Cornerstone of DVT Treatment

What is the main treatment for DVT? Anticoagulation therapy, often referred to as blood thinners, is the primary treatment for DVT. These medications work by preventing the blood clot from growing larger and reducing the risk of new clots forming. Common anticoagulants used in DVT treatment include:

• Heparin (usually low molecular weight heparin)
• Warfarin
• Direct oral anticoagulants (DOACs) such as rivaroxaban, apixaban, or dabigatran

The choice of anticoagulant and duration of treatment depend on various factors, including the patient’s overall health, the size and location of the clot, and the presence of any underlying conditions.

Additional Treatment Measures for DVT

In addition to anticoagulation therapy, other treatments may be recommended to manage DVT:

1. Compression stockings to reduce swelling and improve blood flow
2. Elevation of the affected leg to reduce swelling
3. Physical activity, as advised by the healthcare provider, to promote blood circulation
4. In severe cases, thrombolytic therapy or surgical interventions may be considered

Preventing Deep Vein Thrombosis: Proactive Measures for High-Risk Individuals

Prevention is key in managing the risk of DVT, especially for individuals with known risk factors. Several strategies can help reduce the likelihood of developing blood clots:

Lifestyle Modifications to Reduce DVT Risk

How can one prevent DVT through lifestyle changes? Implementing the following measures can significantly reduce the risk of developing DVT:

• Maintaining a healthy weight through diet and exercise
• Staying active and avoiding prolonged periods of inactivity
• Quitting smoking
• Staying hydrated, especially during long travels
• Wearing loose-fitting clothes and avoiding crossing legs for extended periods

Preventive Measures for High-Risk Situations

In certain high-risk situations, such as during long flights or after surgery, additional preventive measures may be recommended:

1. Wearing compression stockings
2. Taking prescribed anticoagulants as a preventive measure
3. Performing leg exercises or walking regularly during long journeys
4. Following post-operative mobilization instructions carefully

Complications of Deep Vein Thrombosis: Understanding the Risks

While DVT itself is a serious condition, it can lead to potentially life-threatening complications if left untreated. Understanding these risks emphasizes the importance of prompt diagnosis and treatment.

Pulmonary Embolism: A Serious Complication of DVT

What is the most dangerous complication of DVT? Pulmonary embolism (PE) is considered the most severe complication of DVT. It occurs when a piece of the blood clot breaks off and travels through the bloodstream, lodging in the lungs. This can block blood flow to part of the lung, leading to potentially fatal consequences.

Symptoms of pulmonary embolism include:

• Sudden shortness of breath
• Chest pain that worsens with deep breathing
• Rapid heart rate
• Coughing up blood
• Feeling faint or lightheaded

PE is a medical emergency requiring immediate attention. If left untreated, about 1 in 10 people with DVT will develop a pulmonary embolism, underscoring the importance of early DVT detection and treatment.

Post-Thrombotic Syndrome: Long-Term Effects of DVT

Another potential complication of DVT is post-thrombotic syndrome (PTS). This chronic condition can develop months or years after a DVT episode and is characterized by:

• Persistent swelling in the affected limb
• Pain or discomfort, especially when standing or walking
• Skin discoloration or ulceration
• Varicose veins

PTS can significantly impact quality of life and may require ongoing management. Proper treatment of DVT and consistent use of compression stockings can help reduce the risk of developing this condition.

Advancements in DVT Research and Treatment

The field of DVT research is continuously evolving, with new treatments and preventive strategies emerging. Recent advancements include:

Novel Anticoagulants and Their Impact on DVT Management

How have new anticoagulants changed DVT treatment? The introduction of direct oral anticoagulants (DOACs) has revolutionized DVT treatment. These medications offer several advantages over traditional anticoagulants like warfarin:

• More predictable anticoagulant effects
• Fewer food and drug interactions
• No need for regular blood monitoring
• Potentially lower risk of bleeding complications

While DOACs have improved the management of DVT for many patients, they may not be suitable for everyone. The choice of anticoagulant should be made in consultation with a healthcare provider, considering individual patient factors and preferences.

Emerging Technologies in DVT Detection and Prevention

Ongoing research is exploring new technologies to improve DVT detection and prevention:

1. Advanced imaging techniques for more accurate diagnosis
2. Wearable devices to monitor blood flow and detect early signs of clot formation
3. Genetic testing to identify individuals at higher risk for DVT
4. Novel mechanical devices for preventing DVT in hospitalized patients

These advancements hold promise for improving DVT management and reducing the incidence of this potentially dangerous condition.

Living with DVT: Long-Term Management and Quality of Life

For individuals who have experienced DVT, long-term management is crucial to prevent recurrence and maintain quality of life. This involves a combination of medical supervision and lifestyle adjustments.

Ongoing Care and Monitoring After DVT

What does long-term care for DVT patients involve? After the initial treatment phase, ongoing care typically includes:

• Regular follow-up appointments with healthcare providers
• Continued use of anticoagulants as prescribed
• Monitoring for signs of post-thrombotic syndrome
• Periodic reassessment of risk factors and treatment efficacy

Patients should be aware of the signs of recurrent DVT or potential complications and seek medical attention promptly if these occur.

Lifestyle Adjustments for DVT Survivors

Living with DVT often requires certain lifestyle modifications to promote overall health and reduce the risk of recurrence:

1. Maintaining a regular exercise routine, as approved by a healthcare provider
2. Wearing compression stockings as recommended
3. Managing weight through a balanced diet and physical activity
4. Avoiding prolonged periods of immobility
5. Staying hydrated and avoiding excessive alcohol consumption

These adjustments, combined with appropriate medical care, can help individuals with a history of DVT maintain their health and reduce the risk of future complications.

Understanding deep vein thrombosis, its symptoms, causes, and treatment options is crucial for early detection and effective management of this potentially serious condition. By recognizing the risk factors and implementing preventive measures, individuals can reduce their likelihood of developing DVT. For those who have experienced DVT, ongoing care and lifestyle adjustments are key to maintaining long-term health and preventing recurrence. As research in this field continues to advance, new treatments and preventive strategies offer hope for improved outcomes for individuals at risk of or living with DVT.

Deep vein thrombosis (DVT) – Illnesses & conditions

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1. 1.

   About deep vein thrombosis

2. 2.

   Deep vein thrombosis causes

3. 3.

   Deep vein thrombosis treatment

4. 4.

   Complications of deep vein thrombosis

5. 5.

   Deep vein thrombosis prevention

About deep vein thrombosis

Deep vein thrombosis (DVT) is a blood clot that develops within a deep vein in the body, usually in the leg.

Blood clots that develop in a vein are also known as venous thrombosis.

DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh. It can also occur in the pelvis or abdomen.

It can cause pain and swelling in the leg and may lead to complications such as pulmonary embolism. 

DVT and pulmonary embolism together are known as venous thromboembolism (VTE).

DVT symptoms

In some cases, there may be no symptoms of DVT. If symptoms do occur they can include:

• pain, swelling and tenderness in one of your legs (usually your calf or thigh)
• a heavy ache in the affected area
• warm skin in the area of the clot
• red skin, particularly at the back of your leg below the knee

DVT usually (although not always) affects one leg. The pain may be worse when you bend your foot upward towards your knee.

Urgent advice:

Phone 999 or go to A&E if you have symptoms of DVT like:

• pain and swelling of the leg, along with either breathlessness or chest pain

Pulmonary embolism

This is a serious condition that occurs when a piece of blood clot breaks off into the bloodstream. This then blocks one of the blood vessels in the lungs, preventing blood from reaching them.

If left untreated, about 1 in 10 people with a DVT will develop a pulmonary embolism. A pulmonary embolism is a very serious condition which causes:

• breathlessness – which may come on gradually or suddenly
• chest pain – which may become worse when you breathe in
• sudden collapse 

Both DVT and pulmonary embolism need urgent investigation and treatment.

Seek immediate medical attention if you have pain, swelling and tenderness in your leg and develop breathlessness and chest pain.

Read more about the complications of DVT

DVT causes

Each year, DVT affects around 1 person in every 1,000 in the UK.

Anyone can develop DVT, but it becomes more common over the age of 40. As well as age, there are also some other risk factors, including:

• having a history of DVT or pulmonary embolism
• having a family history of blood clots
• being inactive for long periods – such as after an operation or during a long journey
• blood vessel damage – a damaged blood vessel wall can result in the formation of a blood clot
• having certain conditions or treatments that cause your blood to clot more easily than normal – such as cancer (including chemotherapy and radiotherapy treatment), heart and lung disease, thrombophilia and Hughes syndrome
• being pregnant – your blood also clots more easily during pregnancy
• being overweight or obese

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen, which causes the blood to clot more easily. If you’re taking either of these, your risk of developing DVT is slightly increased.

Read more about the causes of DVT

Diagnosing DVT

See your GP as soon as possible if you think you may have DVT – for example, if you have pain, swelling and a heavy ache in your leg. They’ll ask you about your symptoms and medical history.

D-dimer test

It can be difficult to diagnose DVT from symptoms alone. Your GP may advise that you have a specialised blood test called a D-dimer test.

This test detects pieces of blood clot that have been broken down and are loose in your bloodstream. The larger the number of fragments found, the more likely it is that you have a blood clot in your vein.

However, the D-dimer test isn’t always reliable because blood clot fragments can increase after an operation, injury or during pregnancy. Additional tests, such as an ultrasound scan, will need to be carried out to confirm DVT.

Ultrasound scan

An ultrasound scan can be used to detect clots in your veins. A special type of ultrasound called a Doppler ultrasound can also be used to find out how fast the blood is flowing through a blood vessel. This helps doctors identify when blood flow is slowed or blocked, which could be caused by a blood clot.

Venogram

A venogram may be used if the results of a D-dimer test and ultrasound scan can’t confirm a diagnosis of DVT.

During a venogram, a liquid called a contrast dye is injected into a vein in your foot. The dye travels up the leg and can be detected by X-ray, which will highlight a gap in the blood vessel where a clot is stopping the flow of blood.

DVT treatment

Treatment for DVT usually involves taking anticoagulant medicines. These reduce the blood’s ability to clot and stop existing clots getting bigger.

Heparin and warfarin are 2 types of anticoagulant often used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting. After initial treatment, you may also need to take warfarin to prevent another blood clot forming.

A number of anticoagulants, known as directly acting oral anticoagulants (DOACs), may also be used to treat conditions such as DVT. These medications include rivaroxaban and apixaban, and they’ve been shown to be as effective as heparin and warfarin with less serious side effects.

You’ll also be prescribed compression stockings to wear every day, which will improve your symptoms and help prevent complications.

Read more about treating DVT

DVT prevention

If you need to go into hospital for surgery, a member of your care team will assess your risk of developing a blood clot while you’re there.

If you’re at risk of developing DVT, there are a number of things you can do to prevent a blood clot occurring, both before you go into hospital. These include temporarily stopping taking the combined contraceptive pill, and while you’re in hospital, such as wearing compression stockings.

When you leave hospital, your care team may also make some recommendations to help prevent DVT returning or complications developing. These may include:

• not smoking
• eating a healthy, balanced diet
• taking regular exercise 
• maintaining a healthy weight or losing weight if you’re obese

There’s no evidence to suggest that taking aspirin reduces your risk of developing DVT.

See your GP before embarking on long-distance travel if you’re at risk of getting a DVT, or if you’ve had a DVT in the past.

When taking a long-distance journey (6 hours or more) by plane, train or car, you should take steps to avoid getting DVT. Drink plenty of water, perform simple leg exercises and take regular, short walking breaks.

Read more about preventing DVT

Deep vein thrombosis causes

Deep vein thrombosis (DVT) sometimes occurs for no apparent reason.

However, the risk of developing DVT is increased in certain circumstances.

Inactivity 

When you’re inactive your blood tends to collect in the lower parts of your body, often in your lower legs. This is usually nothing to worry about because when you start to move, your blood flow increases and moves evenly around your body.

However, if you’re unable to move for a long period of time – such as after an operation, because of an illness or injury, or during a long journey – your blood flow can slow down considerably. A slow blood flow increases the chances of a blood clot forming.

In hospital

If you have to go into hospital for an operation or procedure, your risk of getting a blood clot increases. This is because DVT is more likely to occur when you’re unwell or inactive, or less active than usual.

As a patient, your risk of developing DVT depends on the type of treatment you’re having. You may be at increased risk of DVT if any of the following apply:

• you’re having an operation that takes longer than 90 minutes, or 60 minutes if the operation is on your leg, hip or abdomen
• you’re having an operation for an inflammatory or abdominal condition, such as appendicitis
• you’re confined to a bed, unable to walk, or spending a large part of the day in a bed or chair for at least three days

You may also be at increased risk of DVT if you’re much less active than usual because of an operation or serious injury and have other DVT risk factors, such as a family history of the condition.

When you’re admitted to hospital you’ll be assessed for your risk of developing a blood clot and, if necessary, given preventative treatment.

Blood vessel damage

If the wall of a blood vessel is damaged, it may become narrowed or blocked, which can cause a blood clot to form.

Blood vessels can be damaged by injuries such as broken bones or severe muscle damage. Sometimes, blood vessel damage that occurs during surgery can cause a blood clot, particularly in operations on the lower half of your body.

Conditions such as vasculitis (inflammation of the blood vessels), varicose veins and some forms of medication, such as chemotherapy, can also damage blood vessels.

Medical and genetic conditions

Your risk of getting DVT is increased if you have a condition that causes your blood to clot more easily than normal. These conditions include:

• cancer – cancer treatments such as chemotherapy and radiotherapy can increase this risk further
• heart disease and lung disease
• infectious conditions, such as hepatitis
• inflammatory conditions, such as rheumatoid arthritis
• thrombophilia – a genetic condition where your blood has an increased tendency to clot
• antiphospholipid syndrome – an immune system disorder that causes an increased risk of blood clots 

Pregnancy

During pregnancy, blood clots more easily. It’s the body’s way of preventing too much blood being lost during childbirth.

Venous thromboembolism (VTE) – DVT and pulmonary embolism – affects about 1 in 100,000 women of childbearing age.

DVTs are also rare in pregnancy, although pregnant women are up to 10 times more likely to develop thrombosis than non-pregnant women of the same age. A clot can form at any stage of pregnancy and up to 6 weeks after the birth.

Having thrombophilia (a condition where the blood has an increased tendency to clot), or having a parent, or brother or sister, who’s had a thrombosis, increase your risk of developing a DVT during pregnancy.

Other risk factors during pregnancy include:

• being over 35 years old
• being obese (with a BMI of 30 or more)
• expecting 2 or more babies
• having recently had a caesarean section
• being immobile for long periods of time
• smoking (find out how to stop smoking)
• having severe varicose veins
• dehydration

Low molecular weight heparin (LMWH) is usually used to treat pregnant women with DVT. LMWH is an anticoagulant, which means it prevents the blood clot getting bigger. It’s given by injection and doesn’t affect your developing baby.

Contraceptive pill and HRT

The combined contraceptive pill and hormone replacement therapy (HRT) both contain the female hormone oestrogen. Oestrogen causes the blood to clot a bit more easily than normal, so your risk of getting DVT is slightly increased. There’s no increased risk from the progestogen-only contraceptive pill.

Other causes

Your risk of getting DVT is also increased if you or a close relative have previously had DVT and:

• you’re overweight or obese
• you smoke
• you’re dehydrated
• you’re over 60 – particularly if you have a condition that restricts your mobility

Deep vein thrombosis treatment

If you have deep vein thrombosis (DVT), you’ll need to take a medicine called an anticoagulant.

Anticoagulation

Anticoagulant medicines prevent blood clots getting bigger.  They can also help stop part of the blood clot breaking off and becoming lodged in another part of your bloodstream (an embolism).

Although they’re often referred to as “blood-thinning” medicines, anticoagulants don’t actually thin the blood. They alter proteins within it, which prevents clots forming so easily.

Heparin and warfarin are 2 types of anticoagulants that are used to treat DVT. Heparin is usually prescribed first because it works immediately to prevent further clotting. After this initial treatment, you may also need to take warfarin to prevent another blood clot forming.

Heparin

Heparin is available in 2 different forms:

• standard (unfractioned) heparin
• low molecular weight heparin (LMWH)

Standard (unfractioned) heparin can be given as:

• an intravenous injection – an injection straight into one of your veins
• an intravenous infusion – where a continuous drip of heparin (via a pump) is fed through a narrow tube into a vein in your arm (this must be done in hospital)
• a subcutaneous injection – an injection under your skin

LMWH is usually given as a subcutaneous injection.

The dose of standard (unfractionated) heparin to treat a blood clot varies significantly from person to person, so the dosage must be carefully monitored and adjusted if necessary. You may need to stay in hospital for 5 to 10 days and have frequent blood tests to ensure you receive the right dose.

LMWH works differently from standard heparin. It contains small molecules, which means its effects are more reliable and you won’t have to stay in hospital and be monitored.

Both standard heparin and LMWH can cause side effects, including:

• a skin rash and other allergic reactions
• bleeding 
• weakening of the bones if taken for a long time (although rare with LMWH)

In rare cases, heparin can also cause an extreme reaction that makes existing blood clots worse and causes new clots to develop. This reaction, and weakening of your bones, is less likely to occur when taking LMWH.

In most cases, you’ll be given LMWH because it’s easier to use and causes fewer side effects.

Warfarin

Warfarin is taken as a tablet. You may need to take it after initial treatment with heparin to prevent further blood clots occurring. Your doctor may recommend that you take warfarin for 3 to 6 months. In some cases, it may need to be taken for longer, even for life.

As with standard heparin, the effects of warfarin vary from person to person. You’ll need to be closely monitored by having frequent blood tests to ensure you’re taking the right dosage.

When you first start taking warfarin, you may need to have 2 to 3 blood tests a week until your regular dose is decided. After this, you should only need to have a blood test every 4 weeks at an anticoagulant outpatient clinic.

Warfarin can be affected by your diet, any other medicines you’re taking, and by how well your liver is working.

If you’re taking warfarin you should:

• keep your diet consistent
• limit the amount of alcohol you drink (no more than 14 units of alcohol a week)
• take your dose of warfarin at the same time every day
• not start to take any other medicine without checking with your GP, pharmacist or anticoagulant specialist
• not take herbal medicines

Warfarin isn’t recommended for pregnant women who are given heparin injections for the full length of treatment.

Rivaroxaban

Rivaroxaban is a medication recommended by the National Institute for Health and Care Excellence (NICE) as a possible treatment for adults with DVT, or to help prevent recurrent DVT and pulmonary embolism.

Rivaroxaban comes in tablet form. It’s a type of anticoagulant known as a directly acting oral anticoagulant (DOAC). It prevents blood clots forming by inhibiting a substance called factor Xa and restricting the formation of thrombin (an enzyme that helps blood clot).

Treatment usually lasts 3 months and involves taking rivaroxaban twice a day for the first 21 days and then once a day until the end of the course.

Read the NICE guidance about rivaroxaban

Apixaban

NICE also recommends apixaban as a possible method of treatment and prevention for DVT and pulmonary embolism.

Like rivaroxaban, apixaban is a DOAC that’s taken orally as a tablet, and prevents blood clots forming by hindering factor Xa and restricting the formation of thrombin.

Treatment usually lasts at least 3 months and involves taking apixaban twice a day.

Read the NICE guidance about apixaban

Compression stockings

Wearing compression stockings helps prevent calf pain and swelling, and lowers the risk of ulcers developing after having DVT.

They can also help prevent post-thrombotic syndrome. This is damage to leg tissue caused by the increase in venous pressure that occurs when a vein is blocked by a clot and blood is diverted to the outer veins.

After having DVT, stockings should be worn every day for at least 2 years. This is because symptoms of post-thrombotic syndrome may develop several months or even years after having a DVT.

Compression stockings should be fitted professionally and your prescription should be reviewed every 3 to 6 months. The stockings need to be worn all day but can be taken off before going to bed or in the evening while you rest with your leg raised. A spare pair of compression stockings should also be provided.

Exercise

Your healthcare team will usually advise you to walk regularly once compression stockings have been prescribed. This can help prevent symptoms of DVT returning and may help to improve or prevent complications of DVT, such as post-thrombotic syndrome.

Raising your leg

As well as wearing compression stockings, you might be advised to raise your leg whenever you’re resting. This helps to relieve the pressure in the veins of the calf and stops blood and fluid pooling in the calf itself.

When raising your leg, make sure your foot is higher than your hip. This will help the returning blood flow from your calf. Putting a cushion underneath your leg while you’re lying down should help raise your leg above the level of your hip.

You can also slightly raise the end of your bed to ensure that your foot and calf are slightly higher than your hip.

Read more about preventing DVT

Inferior vena cava filters

Although anticoagulant medicines and compression stockings are usually the only treatments needed for DVT, inferior vena cava (IVC) filters may be used as an alternative. This is usually because anticoagulant treatment needs to be stopped, isn’t suitable, or isn’t working.

IVC filters are small mesh devices that can be placed in a vein. They trap large fragments of a blood clot and stop it travelling to the heart and lungs. They can be used to help prevent blood clots developing in the legs of people diagnosed with:

• DVT
• pulmonary embolism
• multiple severe injuries

IVCs can be placed in the vein permanently, or newer types of filters can be placed temporarily and removed after the risk of a blood clot has decreased.

The procedure to insert an IVC filter is carried out using a local anaesthetic (where you’re awake but the area is numb). A small cut is made in the skin and a catheter (thin, flexible tube) is inserted into a vein in the neck or groin area. The catheter is guided using an ultrasound scan. The IVC filter is then inserted through the catheter and into the vein.

Complications of deep vein thrombosis

The 2 main complications of deep vein thrombosis (DVT) are pulmonary embolism and post-thrombotic syndrome.

Pulmonary embolism

A pulmonary embolism is the most serious complication of DVT. It happens when a piece of blood clot (DVT) breaks off and travels through your bloodstream to your lungs, where it blocks one of the blood vessels. In severe cases this can be fatal.

If the clot is small, it might not cause any symptoms. If it’s medium-sized, it can cause chest pain and breathing difficulties. A large clot can cause the lungs to collapse, resulting in heart failure, which can be fatal.

About one in 10 people with an untreated DVT develops a severe pulmonary embolism.

Post-thrombotic syndrome

If you’ve had a DVT, you may develop long-term symptoms in your calf known as post-thrombotic syndrome. This affects around 20-40% of people with a history of DVT.

If you have DVT, the blood clot in the vein of your calf can divert the flow of blood to other veins, causing an increase in pressure. This can affect the tissues of your calf and lead to symptoms, including:

• calf pain
• swelling
• a rash 
• ulcers on the calf (in severe cases) 

When a DVT develops in your thigh vein, there’s an increased risk of post-thrombotic syndrome occurring. It’s also more likely to occur if you’re overweight or if you’ve had more than one DVT in the same leg.

Deep vein thrombosis prevention

If you’re admitted to hospital or planning to go into hospital for surgery, your risk of developing a blood clot while you’re there will be assessed.

Surgery and some medical treatments can increase your risk of developing DVT – see causes of DVT for more information.

If you’re thought to be at risk of developing DVT, your healthcare team can take a number of measures to prevent a blood clot forming.

Before going into hospital

If you’re going into hospital to have an operation, and you’re taking the combined contraceptive pill or hormone replacement therapy (HRT), you’ll be advised to temporarily stop taking your medication four weeks before your operation.

Similarly, if you’re taking medication to prevent blood clots, such as aspirin, you may be advised to stop taking it one week before your operation.

There’s less risk of getting DVT when having a local anaesthetic compared with a general anaesthetic.  Your doctor will discuss whether it’s possible for you to have a local anaesthetic.

While you’re in hospital

There are a number of things your healthcare team can do to help reduce your risk of getting DVT while you’re in hospital.

For example, they’ll make sure you have enough to drink so you don’t become dehydrated, and they’ll also encourage you to move around as soon as you’re able to.

Depending on your risk factors and individual circumstances, a number of different medications can be used to help prevent DVT. For example:

• anticoagulant medicines – such as dabigatran etexilate or fondaparinux sodium, which are often used to help prevent blood clots after certain types of surgery, including orthopaedic surgery
• low molecular weight heparin (LMWH) – often used in many cases to help prevent blood clots, including during and shortly after pregnancy
• unfractionated heparin (UFH) – often used in people with severe kidney impairment or established kidney failure 

Compression stockings or compression devices are also commonly used to help keep the blood in your legs circulating.

Compression stockings are worn around your feet, lower legs and thighs, and fit tightly to encourage your blood to flow more quickly around your body.

Compression devices are inflatable and work in the same way as compression stockings, inflating at regular intervals to squeeze your legs and encourage blood flow.

Your healthcare team will usually advise you to walk regularly after you’ve been prescribed compression stockings. Keeping mobile can help prevent the symptoms of DVT returning and may help prevent or improve complications of DVT, such as post-thrombotic syndrome.

Read more about treating DVT

When you leave hospital

You may need to continue to take anticoagulant medicine and wear compression stockings when you leave hospital.

Before you leave, your healthcare team should advise you about how to use your treatment, how long to continue using it for, and who to contact if you experience any problems.

Lifestyle changes

You can reduce your risk of getting DVT by making changes to your lifestyle, such as:

• not smoking
• eating a healthy, balanced diet
• getting regular exercise 
• maintaining a healthy weight or losing weight if you’re obese

Travelling

See your GP before long-distance travel if you’re at risk of getting a DVT, or if you’ve had a DVT in the past.

If you’re planning a long-distance plane, train or car journey (journeys of six hours or more), make sure you:

• drink plenty of water
• avoid drinking excessive amounts of alcohol because it can cause dehydration
• avoid taking sleeping pills because they can cause immobility
• perform simple leg exercises, such as regularly flexing your ankles
• take occasional short walks when possible – for example, during refuelling stopovers
• wear elastic compression stockings

Read more about preventing DVT when you travel

Travel insurance

If you’re travelling abroad, it’s very important to ensure you’re prepared should you or a family member fall ill.

Make sure you have full travel insurance to cover the cost of any healthcare you may need while abroad. This is particularly important if you have a pre-existing medical condition, such as cancer or heart disease, which may increase your risk of developing DVT.

DVT can be a very serious condition, and it’s important you receive medical assistance as soon as possible. Treating DVT promptly will help minimise the risk of complications.

What Do Blood Clots in the Leg Feel Like?

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

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

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

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

Signs that you may have a blood clot

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

Symptoms include:

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

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

Blood clots are more common among people who:

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

Can kids get blood clots in the leg?

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

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

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

When to seek care for a possible blood clot

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

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

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

Healthy habits may lower your risk of blood clots

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

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

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

Next Steps & Resources:

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

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

Venous thrombosis – what is it, symptoms

Venous thrombosis refers to acute diseases. There are many reasons for its occurrence, the main ones are a violation of the structure of the venous wall during surgery, trauma, radiation and chemotherapy, a slowdown in blood flow, and increased blood clotting.

According to the cause of occurrence venous thromboses are divided into several types:0004 due to blood pressure on the veins)

Venous thrombosis can also be divided by localization:

• thrombosis superficial (subcutaneous) veins lower extremities (in clinical practice referred to as thrombophlebitis , is a common complication of varicose veins – inflammation in the walls of the veins increases the tendency to form blood clots)
• deep vein thrombosis of the lower extremities

Characteristic symptoms of thrombophlebitis of superficial veins:

• Constant pulling, burning pain along the thrombosed veins, which may restrict movement in the affected limb
• Redness of the skin in the area of ​​the affected vein
• Local (local) temperature increase in the area of ​​the affected vein
• Hypersensitivity in the affected area of ​​the limb
• Moderate swelling in the ankles and lower third of the legs
• Dilation of the small saphenous veins

Thrombus formation can begin anywhere in the venous system, but most often in the deep veins of the leg.

Typical symptoms seen with deep vein thrombosis include:

1. Swelling of all or part of a limb
2. Discoloration of the skin (development of cyanosis – cyanosis
   skin of the lower extremities) or increased pattern of saphenous veins
3. Bursting pain in limb

Blood clots are usually located in the veins of the legs, thighs and pelvis. A person may not be aware that they have a blood clot until the clot causes significant obstruction to blood flow or the clot particles break off. With the development of thrombosis in the veins of the lower extremities, swelling and pain in the leg may appear.

Venous thrombosis is very dangerous and poses a great threat to human life and health. A blood clot formed in the deep veins of the lower leg can travel with the bloodstream to the pulmonary artery, causing partial or complete disruption of blood flow in it (this condition is called pulmonary embolism). Venous thrombosis does not always pass without a trace, and after a thrombosis, a person may develop the so-called post-thrombotic disease, which manifests itself in constant swelling of the limb and the formation of trophic ulcers.

Venous thrombosis and its most dangerous complication – pulmonary embolism (PE) – are the most frequent companions of many patients in therapeutic and surgical hospitals.

Pulmonary Artery Thromboembolism (PE) is a severe life-threatening disease in which there is complete or partial occlusion of the lumen of the pulmonary artery by a thrombus. As a rule, PE is a complication of deep vein thrombosis of the legs.

Signs observed in PE are varied and not very specific.

The most common:

• Shortness of breath of varying severity (from mild to severe)
• Chest pain (in most cases “pleural”, aggravated by breathing)
• Hemoptysis is a rare symptom, body temperature may rise, cough may later join (as a rule, these signs are observed with a small embolism of small branches of the pulmonary artery)
• Shock or a sharp decrease in pressure with the development of a massive lesion of the pulmonary artery, there may be impaired consciousness

If you experience the symptoms described above, you should immediately seek medical attention at the nearest medical facility!

Sources:

1. Kirienko A. I., Panchenko E.P., Andriyashkin V.V. Venous thrombosis in the practice of a therapist and surgeon.-M: Planida, 2012.-336s.
2. Kirienko et al. .“Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications”, journal Phlebology 2015;4 (2):3-52
3. Ioskevich N.N. Practical guide to clinical surgery: Diseases of the chest, blood vessels, spleen and endocrine glands. Minsk. Higher School. 2002. 479 p.

SARU.ENO.19.06.1021

symptoms, causes, diagnosis, treatment| JSC “Medicina” (clinic of Academician Roitberg)

Contents of the article

1. General information
2. Causes of thrombosis
3. Symptoms of thrombosis
4. Complications of disease
5. Diagnosis of arterial thrombosis
6. Treatment
7. Thrombosis prophylaxis
8. Questions and Answers
9. Sources

General information

Thrombosis is a pathological process of the formation of numerous blood clots in the vessels, preventing proper blood circulation. The consequence of this phenomenon is ischemia associated with tissue malnutrition, and their subsequent necrosis. With complete blockage of large blood vessels, a condition occurs that threatens the life of the patient. The most dangerous is arterial thrombosis, which prevents the full functioning of the heart and causes oxygen starvation of tissues.

Causes of thrombosis

There are three main causes that can cause vascular thrombosis:

• Damage to the walls of the bloodstream caused by trauma, surgery, dietary disorders, infection of the body, after lifting weights, during labor, etc.
• A bleeding disorder resulting in increased thrombus formation due to a metabolic or hormonal imbalance.
• Blood stasis associated with prolonged immobility of the human body during a long-haul flight, travel by car, due to a serious illness, etc.

An additional factor that increases the risk of thrombosis is varicose veins, overweight, inactive lifestyle and age over 60 years.

Symptoms of thrombosis

Symptoms depend on the type of thrombosis and its location in an artery or vein. The arterial variety is characterized by:

• A sharp throbbing pain that spreads from the point of blockage of the vein.
• Feeling of numbness in the limb or area of ​​the body where the thrombus is located, due to which the body temperature in this area drops sharply.
• Irregular heart rhythm, shortness of breath, feeling of pressure inside the sternum.
• Speech disorder, dizziness and headache if thrombosis cuts off blood flow to the brain.

During an exacerbation of venous thrombosis, patients complain of:

• Sharply increasing pain.
• Thickening and swelling of tissues in the area of ​​thrombus formation and blood stasis.
• Swelling of the veins located closer to the surface of the body.
• Blue skin caused by tissue numbness and dark venous blood inflow.

The appearance of at least one of the listed signs should be a reason for immediate seeking emergency medical care.

Complications of the disease

The danger of thrombosis lies in its ability to create conditions that are dangerous to human life. among the most probable complications:

• Inflammation of the lungs, which can lead to the death of the tissues of these organs.
• Pleurisy destroying lungs externally.
• Oxygen starvation, disrupting the full functioning of internal organs.
• Relapses of a disease that worsens within a calendar year of the first occurrence.

Preventive measures recommended for a particular patient, taking into account his condition, allow to exclude an unfavorable scenario.

Diagnosis of arterial thrombosis

To clarify the state of the vessel duct and the presence of accumulation of blood clots in it, the following research methods allow:

• Laboratory blood test for coagulation parameters.
• Magnetic resonance phlebography.
• Scanning of arteries and veins of the lower extremities by duplex or triplex method.
• The so-called ascending phlebography with the introduction of a contrast agent into the vessels.
• Radionuclide scanning of the thrombus location.
• Thromboelastography.

Treatment

Some of the most effective ways to treat thrombosis, provided you seek help in a timely manner, are:

• Anticoagulation – taking drugs that slow down the process of blood clotting and activate the process of blood circulation.
• Placement of catheters delivering a drug to dissolve a blood clot directly to the site of its localization. The method is rarely used due to its technical complexity.
• Systemic thrombolysis, aimed at taking drugs to dissolve blood clots.

If a large thrombus has formed, the patient is indicated for surgery to remove the obstruction to the blood flow.

It is possible to consolidate the results of treatment and reduce the risk of relapse only if preventive measures are observed.

Prevention of thrombosis

To reduce the risk of developing the disease or its recurrence:

• Wearing compression underwear, selected taking into account the parameters of the patient’s body.
• Stop smoking, alcohol and drugs.
• Taking vitamin complexes, reviewing the diet in favor of foods with a high content of vitamins and microelements – potassium, magnesium, etc.
• Moderate physical activity, sports, refusal of a sedentary lifestyle.
• Timely treatment of existing diseases that negatively affect the state of blood vessels and blood clotting.
• Control of glucose and cholesterol levels to prevent the formation of atherosclerotic plaques.
• Measures to reduce excess body weight.

All of the above measures contribute to the restoration of blood flow and eliminate the risk of increased thrombosis.

Questions and Answers

• Who should I contact if I suspect a thrombosis?
• Diagnosis and treatment for a patient with thrombosis is the responsibility of a phlebologist. Often, a vascular surgeon, a cardiologist, a neurologist and other highly specialized doctors are involved in the work, taking into account the underlying disease of the patient and the state of his body.
• Is it possible to do without surgery for thrombosis?
• It is possible to avoid surgery if conservative treatment is effective and small blood clots form in the vessels, the movement of which does not pose a risk of blockage of the vessels.
• Is the hereditary factor relevant in thrombosis?
• Most phlebologists point to external causes of the disease, which do not depend on genetic predisposition. Often, the health of citizens who do not have the prerequisites for the development of the disease face the problem of intense thrombosis.

References

The following literature was used in the preparation of the material:

• Pokrovsky A.V., Doguzhieva R.M., Bogatov Yu.P., Goltsova E.E., Lebedeva A.N. Long-term results of aortofemoral reconstructions in patients with type 2 diabetes mellitus. Angiology and vascular surgery. 2010; 16:1:48-52.
• National guidelines for the management of patients with diseases of the arteries of the lower extremities – M.: 2013.
• Zoloev G.K., Koval O.A., Litvinovsky S.V., Ivatsin N.P. Specific complications of semi-closed endarterectomy from the iliac arteries. Angiology and vascular surgery. 2006; 4:12:121-126.
• Gadeev AK, Lukanikhin VA, Bredikhin RA, Ignatiev IM Thrombolytic therapy in acute arterial thrombosis. Angiology and Vascular Surgery, 2012
• Appendix (Materials 23 (XXYII) of the International Conference in St. Petersburg). 71-73.

Author of article

Ablyazov

Irshat Ravilevich

Experience 23 years

District therapist

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