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Symptoms of Blood Clots in Lower Legs: Deep Vein Thrombosis (DVT) – Symptoms and Causes

What are the symptoms of blood clots in the lower legs? What causes deep vein thrombosis (DVT)?

How Does Blood Clot?

Blood has a seemingly impossible job: It must flow continuously and smoothly throughout your body for an entire lifetime, but quickly shut off to prevent spills when you get a cut or injury. Blood clots are healthy and lifesaving when they stop bleeding. But they can also form when they aren’t needed and cause a heart attack, stroke, or other serious medical problems.

The life cycle of a normal blood clot depends on a series of chemical interactions:

  1. Platelets form a plug. Tiny bits in your blood called platelets get “turned on” by triggers released when a blood vessel is damaged. They stick to the walls in the area and each other, changing shape to form a plug that fills in the broken part to stop blood from leaking out.
  2. The clot grows. Proteins in your blood called clotting factors signal each other to cause a rapid chain reaction. It ends with a dissolved substance in your blood turning into long strands of fibrin. These get tangled up with the platelets in the plug to create a net that traps even more platelets and cells. The clot becomes much tougher and more durable.
  3. Reactions stop its growth. Other proteins offset extra clotting factor proteins so the clot doesn’t spread farther than it needs to.
  4. Your body slowly breaks it down. As the damaged tissue heals, you don’t need the clot any more. The tough fibrin strands dissolve, and your blood takes back the platelets and cells of the clot.

What Causes Blood Clots?

The process begins whenever flowing blood comes into contact with specific substances in your skin or in blood vessel walls. When they touch, it usually means the skin or blood vessel wall is broken. Waxy cholesterol plaques that form in arteries have these things inside, too. If the plaque breaks open, they’ll start the clotting process. Most heart attacks and strokes happen when a plaque in your heart or brain suddenly bursts.

Blood clots can also form when your blood doesn’t flow properly. If it pools in your blood vessels or heart, the platelets are more likely to stick together. Atrial fibrillation and deep vein thrombosis (DVT) are two conditions where slowly moving blood can cause clotting problems.

How Do Medications Affect the Clotting Process?

Some drugs stop platelets from signaling each other so they won’t stick together:

  • Aspirin
  • Clopidogrel (Plavix)
  • Dipyridamole (Persantine)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Ticlopidine (Ticlid)

Medicines called blood thinners make it hard for your body to make clotting factors, or they prevent proteins in the clot-forming process from working:

  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa)
  • Edoxaban (Savaysa)
  • Heparin
  • Rivaroxaban (Xarelto)
  • Warfarin (Coumadin)

Clot-dissolving drugs such as alteplase, streptokinase, and tenecteplase activate the protein that breaks down the fibrin strands. Sometimes doctors prescribe it as a treatment for heart attack or stroke.

What Are the Symptoms of Deep Vein Thrombosis (DVT)?

Deep vein thrombosis (DVT) is a condition where a blood clot forms in a deep vein, usually in the leg. The main symptoms of DVT include:

  • Swelling in the affected leg
  • Pain or tenderness in the leg
  • Warmth in the affected area
  • Redness of the skin on the leg

Not everyone with DVT has symptoms, but if the clot breaks off and travels to the lungs, it can cause a life-threatening condition called pulmonary embolism. Symptoms of pulmonary embolism include chest pain, shortness of breath, and coughing up blood.

What Causes Deep Vein Thrombosis (DVT)?

There are several factors that can increase the risk of developing DVT:

  • Prolonged immobility, such as from being hospitalized or taking long plane flights
  • Recent surgery, especially on the hip, knee, or abdomen
  • Cancer and its treatments
  • Pregnancy
  • Obesity
  • Smoking
  • Inherited blood clotting disorders

If you have any of these risk factors, it’s important to take steps to prevent DVT, such as getting up and moving around regularly, wearing compression stockings, and taking blood thinners if prescribed by your doctor.

How Can I Improve My Circulation?

Here are 12 tips to improve your circulation:

  1. Quit smoking. Nicotine harms your artery walls and thickens your blood.
  2. Monitor your blood pressure. High blood pressure can lead to arteriosclerosis and restricted blood flow.
  3. Stay hydrated. Blood is about half water, so drinking enough fluids is important for circulation.
  4. Limit sitting for long periods. Prolonged sitting can slow down blood flow.
  5. Exercise regularly. Physical activity helps pump blood throughout your body.
  6. Elevate your legs. This can help reduce swelling and improve blood flow.
  7. Eat a healthy diet. Foods high in antioxidants and omega-3s can support circulatory health.
  8. Manage stress. Chronic stress can constrict blood vessels and impair circulation.
  9. Get enough sleep. Sleep deprivation can negatively affect your circulation.
  10. Massage your legs. Gentle massage can help stimulate blood flow.
  11. Wear compression stockings. These can improve circulation in the legs.
  12. Consider supplements. Some supplements like ginkgo biloba may help improve circulation.

By making some simple lifestyle changes, you can help improve your circulation and reduce your risk of circulatory problems.

Why Is Good Circulation Important?

Good circulation is essential for overall health and well-being. When your circulatory system is working properly, it delivers oxygen and nutrients to your cells and removes waste products. Poor circulation can lead to a variety of issues, including:

  • Cold hands and feet
  • Numbness or tingling in the extremities
  • Slow wound healing
  • Erectile dysfunction in men
  • Increased risk of heart disease and stroke

By taking steps to improve your circulation, you can help reduce your risk of these and other health problems. Maintaining good circulatory health should be a priority for everyone.

Blood Clots – How They Form and Common Causes

Written by Matthew Hoffman, MD

  • How Does Blood Clot?
  • What Causes Blood Clots?
  • Medications Affect the Clotting Process

Blood has a seemingly impossible job: It must flow continuously and smoothly throughout your body for an entire lifetime, but quickly shut off to prevent spills when you get a cut or injury.

Blood clots are healthy and lifesaving when they stop bleeding. But they can also form when they aren’t needed and cause a heart attack, stroke, or other serious medical problems.

The life cycle of a normal blood clot depends on a series of chemical interactions.

1. Platelets form a plug. Tiny bits in your blood called platelets get “turned on” by triggers released when a blood vessel is damaged. They stick to the walls in the area and each other, changing shape to form a plug that fills in the broken part to stop blood from leaking out.

When activated, platelets also release chemicals to attract more platelets and other cells, and to set off the next step.

2. The clot grows. Proteins in your blood called clotting factors signal each other to cause a rapid chain reaction. It ends with a dissolved substance in your blood turning into long strands of fibrin. These get tangled up with the platelets in the plug to create a net that traps even more platelets and cells. The clot becomes much tougher and more durable.

3. Reactions stop its growth. Other proteins offset extra clotting factor proteins so the clot doesn’t spread farther than it needs to.

4. Your body slowly breaks it down. As the damaged tissue heals, you don’t need the clot any more. The tough fibrin strands dissolve, and your blood takes back the platelets and cells of the clot.

The process begins whenever flowing blood comes into contact with specific substances in your skin or in blood vessel walls. When they touch, it usually means the skin or blood vessel wall is broken.

Waxy cholesterol plaques that form in arteries have these things inside, too. If the plaque breaks open, they’ll start the clotting process. Most heart attacks and strokes happen when a plaque in your heart or brain suddenly bursts.

Blood clots can also form when your blood doesn’t flow properly. If it pools in your blood vessels or heart, the platelets are more likely to stick together. Atrial fibrillation and deep vein thrombosis (DVT) are two conditions where slowly moving blood can cause clotting problems.

Some drugs stop platelets from signaling each other so they won’t stick together.

  • Aspirin
  • Clopidogrel (Plavix)
  • Dipyridamole (Persantine)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Ticlopidine (Ticlid)

Medicines called blood thinners  make it hard for your body to make clotting factors, or they prevent proteins in the clot-forming process from working.

  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa)
  • Edoxaban (Savaysa)
  • Heparin
  • Rivaroxaban (Xarelto)
  • Warfarin (Coumadin)

Clot-dissolving drugs such as alteplase, streptokinase, and tenecteplase activate the protein that breaks down the fibrin strands. Sometimes doctors prescribe it as a treatment for heart attack or stroke.

12 Tips to Improve Your Circulation

Medically Reviewed by Dany Paul Baby, MD on March 06, 2022

It’s hard to believe, but your body holds about 60,000 miles of blood vessels. Along with your heart and other muscles, they make up your circulatory system. This network of roadways carries blood to every corner of your body. But when your circulation is poor, it slows or blocks the blood flow. That means the cells in your body can’t get all the oxygen and nutrients they need.

When your limbs can’t get enough blood, your hands or feet may feel cold or numb. If you’re light-skinned, your legs might get a blue tinge. Poor circulation also can dry your skin, turn your nails brittle, and make your hair fall out, especially on your feet and legs. Some men may have trouble getting or keeping an erection. And if you have diabetes, your scrapes, sores, or wounds tend to heal slower.

Nicotine is the active ingredient in cigarettes, electronic cigarettes, and smokeless tobacco. It harms the walls of your arteries and thickens your blood so much, it can’t get through. If you smoke, quit. It can be hard to stick with it, but your pharmacy or doctor’s office can help.

If it’s too high, it can cause arteriosclerosis, a condition that hardens your arteries and can help choke off blood flow. Aim for 120 mmHg over 80 mmHg or less, but ask your doctor about the best numbers for your age and health. Check your reading at least once a month. You can buy a home blood pressure monitor or use a kiosk at your pharmacy.

Blood is about half water. So you need to stay hydrated to keep it moving. Aim for 8 glasses of water a day. You’ll need to drink more if you exercise or if it’s hot outside.

Sitting for hours at a time isn’t great for your circulation or your back. It weakens leg muscles and slows the blood flow in your legs, which could cause a clot. If you’re a desk jockey at work, consider a standing desk instead. It may take a little while to get used to, but getting on your feet works the valves in your leg veins, sending blood up to your heart.  

Yoga is a low-impact exercise that can jump-start your blood flow. When you move, it brings oxygen to your cells. When you twist, it sends blood to your organs. And upside-down positions shift blood from the bottom half of your body up to your heart and brain. 

Not a yogi? When your ankles or feet swell, try the legs-up-the-wall yoga pose. Also called viparita karani, it’s an easy way to send your blood in the other direction. Lie on the floor or on a yoga mat, with your left or right shoulder close to the wall. Turn your body so you can put your feet up, and scooch your bottom against the wall. Stretch your arms out on the floor with palms down for balance.

Aerobic means “with oxygen.” So when you run, bike, walk, swim, and do similar exercises, you take in more oxygen and move it to your muscles. This gets your blood pumping, makes your heart stronger, and lowers your blood pressure. Set a goal to exercise for 30 minutes, 5 to 7 days a week. Break it up into small chunks if needed. If you walk, know that moderate to intense speeds — at least 3 miles an hour — offer the best health benefits.

This form of strength training not only gets your blood pumping, it also helps lower your blood sugar and helps with back pain. Start with your feet shoulder-width apart and your arms at your sides. Now slowly bend at your hips and knees, but keep your back straight, like you’re sitting in a chair. As you return to the starting position, bend your arms for balance.

Put your wardrobe to work. Compression socks put a bit of squeeze on your legs so your blood doesn’t hang around too long. Instead, it’ll move back up to your heart. Ask your doctor which length and amount of pressure are best for you.

Let’s face it: There’s no downside to a balanced diet. Eat lots of fruits and vegetables. Stay away from saturated fats that can be found in red meat, chicken, cheese, and other animal sources. Steer clear of too much salt. That will help keep your weight in a healthy range and your cholesterol and blood pressure in check — and your arteries clear.  

Sweep your blood in the right direction. Take a body brush with stiff, flat bristles and stroke on your dry skin. Start with your feet and work your way up, using long motions on your legs and arms. Make circles on your belly and lower back. Dry brushing also gets rid of dry skin. Do it every day, right before your shower.

It’s a temporary fix, but a bath is a great way to kick-start your circulation. Warm water makes your arteries and veins open a bit wider, letting more blood through. Hot water or tea does the trick as well.

IMAGES PROVIDED BY:

1) Thinkstock

2) Thinkstock

3) Thinkstock

4) Thinkstock

5) Getty

6) Thinkstock

7) Thinkstock

8) Thinkstock

9) Thinkstock

10) Thinkstock

11) Thinkstock

12) Thinkstock

13) Thinkstock

14) Thinkstock

 

SOURCES:

Circulation Foundation: “The Circulatory System.”

Diabetes.co.uk: “Poor Blood Circulation,” “Diabetes and Smoking.

Mayo Clinic: “Arteriosclerosis/atherosclerosis.”

Circulation Foundation: “Vascular Health.”

Johnston UNC Health Care: “5 Tips To Improve Blood Circulation.”

University of Washington: “12 Reasons Yoga Helps Improve Life Span.”

Cleveland Clinic: “Aerobic Exercise,” “The Truth About Dry Brushing and What It Does for You.”

Arthritis Foundation: “12 Benefits of Walking.”

National Center for Biotechnology Information: “Effects of a mini-trampoline rebounding exercise program on functional parameters, body composition and quality of life in overweight women.”

Harvard Health Publishing: “Yoga for Better Sleep,” “The 4 most important types of exercise.”

Harvard Business Review: “The Many Benefits of Standing at Your Desk,” “Boosting circulation with compression stockings.”

Circulation Foundation: “A Healthy Diet.”

National Institute on Drug Abuse: “Electronic Cigarettes (E-cigarettes).”

American Academy of Otolaryngology-Head and Neck Surgery: “Smokeless Tobacco.

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Deep vein thrombosis of the lower extremities

Deep vein thrombosis is a pathological condition in which blood clots form in the deep veins of the extremities. This can lead to various consequences – up to the death of the patient. Most often, deep vein thrombosis develops in the lower extremities. However, it can also form on the hands.

  • Causes and symptoms
  • Symptoms of deep vein thrombosis
  • Methods for the treatment of thrombosis
  • Appointment

Distinguish between occlusive and non-occlusive thrombosis. In the first case, there is a complete overlap of the lumen of the vessel. This causes circulatory disorders and, as a result, the development of clinical symptoms. With non-occlusive thrombosis, the lumen of the vein is not completely blocked. Therefore, blood circulation is preserved, respectively, the symptoms may be absent or be erased. In this group of diseases, the greatest danger is represented by floating thrombi, one end of which is attached to the venous wall, and the other freely floats in the vessel. At any time, it can break off, enter the bloodstream and cause pulmonary embolism (PE), which is associated with a high risk of death.

Initial consultation of a vascular surgeon, phlebologist, Ph.D. Solomakhina A.E. 3 800 ₽/session
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Deep vein thrombosis may develop as a result of the following causes:

  1. Damage to the vein. Such a situation may arise as a result of mechanical trauma, chemical burns, the action of allergens or infectious agents.
  2. Changes in hemostasis towards hypercoagulability and inhibition of fibrinolysis, the system responsible for blood clotting.
  3. Deceleration of blood flow in a vein. It can be caused by a long stay in one position, compression of blood vessels by tumors, bone fragments, inflammatory infiltrates, prolonged bed rest.

Blood clots can form as a result of either one of these causes, or all three combined. The following factors increase the risk of their formation:

  • surgical interventions;
  • fractures of large bones;
  • burns;
  • oncopathology;
  • respiratory and heart failure;
  • prolonged immobilization. Including during trips or long illnesses;
  • severe extensive trauma;
  • pregnancy;
  • hereditary thrombophilias;
  • certain infectious diseases;
  • sepsis.

Most often, thrombosis occurs in the deep veins of the leg, but theoretically can occur in any vessel. It happens that initially the process was localized in the saphenous veins, but moved to deep perforators.

With occlusive thrombi, there is a clinic of circulatory disorders:

  1. Swelling of the entire leg or part of it.
  2. Blue skin and increased venous pattern.
  3. Bursting pain.
  4. Pain along the neurovascular bundle.

In non-occlusive thrombi, circulation in the vein is preserved. In this case, primary symptoms are often absent. The clinic develops only if the thrombus “comes off” and PE develops.

Complications

Frequent complications of deep vein thrombosis are the development of chronic venous insufficiency, which is aggravated by local circulatory disorders. As a result, there are swelling, pain in the legs, cramps, skin pigmentation disorders and even trophic ulcers, as well as inflammatory diseases, such as eczema.

The most dangerous complication is PE. Violation of blood circulation in the lungs leads to acute respiratory and heart failure and can even lead to the death of the patient. Most often, such complications occur against the background of floating blood clots. Parietal and occlusive are less dangerous.

Diagnostic methods

It is difficult to confirm or exclude the presence of blood clots based on the clinical picture. Therefore, instrumental and laboratory studies are necessary to make a diagnosis:

  • determination of D-dimers. The method has high sensitivity, but low specificity: this marker can increase with a large number of pathologies. For example, in cancer and inflammatory diseases, in the postoperative period. Also, an increase in D-dimers is possible under certain physiological conditions, in particular in the elderly and in pregnant women. In addition, this marker determines the presence of thrombosis, but does not show its localization. Therefore, it must be supplemented by other methods.
  • ultrasound. Compression ultrasound angioscanning is used to detect deep vein thrombosis.

The following methods are used to treat deep vein thrombosis:

  • anticoagulant therapy;
  • bed rest;
  • compression therapy;
  • surgical treatment.

The basis of treatment is anticoagulant therapy. It is prescribed to all patients, including those with asymptomatic pathology. If there is reason to believe that the patient has thrombosis, then therapy should begin immediately, even before verification. Treatment begins with parenteral administration of drugs, i.e. in the form of injections. This continues for at least 5 days. Then the issue of transferring the patient to long-term oral medication (orally, in the form of tablet forms) is considered. Sometimes parenteral administration of anticoagulants can be continued for a longer period – up to several months. The duration of therapy with oral drugs is determined by individual risks and averages 3-6 months. In some cases, it is appointed for life.

The second point is the need for bed rest. It is given to all patients suspected of having deep vein thrombosis until the problem is visualized. If the thrombus is occlusive or parietal, activation is possible. When floating, bed rest is maintained to prevent separation and development of PE.

For compression, preference is given to grade 2-3 knitwear. If the edema is unstable during the day, elastic bandages can be used. Compression is contraindicated in the presence of arterial obliteration and a number of dermatological diseases localized in the affected area.

Surgical treatment is aimed at preventing PE and, if possible, restoring blood flow to the affected area of ​​the vessel. The following types of operations are used:

  • installation of cava filters – special devices that will trap blood clots. The procedure will not allow them to move into the vital organs;
  • thrombectomy. This is the removal of a blood clot;
  • vein plication. Suturing the lumen of the vessel in several places so that it retains its patency for blood flow, but does not let a blood clot through.
  • regional thrombolytic therapy. Drugs are injected into thrombotic masses that destroy it.

Each of the surgical methods has its indications, contraindications and risks.

Thrombosis prevention

A wide range of interventions are used in the prevention of deep vein thrombosis. First of all, patients from the high and moderate risk groups are identified. There are different scales for this, for example Caprini. For the prevention itself, the following methods are used:

  • drug therapy – prescription of anticoagulants. Used in high and moderate risk groups;
  • mechanical prophylaxis. Can be used in groups of any risk. It involves the use of compression hosiery and massage, various devices that carry out flexion-extension of the legs, etc .;
  • early activation of patients in the postoperative period. Used for surgical patients.

The duration of thrombosis prophylaxis is determined by the attending physician, depending on the specific clinical situation of the patient.

The slightest suspicion of the above described deep vein thrombosis requires immediate referral to a specialist and the appointment of anticoagulant therapy!

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symptoms, signs and methods of treatment of vein thrombosis in Moscow at the Center for Surgery “SM-Clinic”

About the disease

Classification of vein thrombosis

Symptoms of thrombosis

Diagnostics

Operations for vein thrombosis

Rehabilitation after surgical treatment

Expert opinion

Questions and answers

About disease

Thrombosis is a condition in which a blood clot (thrombus) forms in the lumen of a vessel. As a rule, it develops in the venous bed of the lower extremities, since the speed of blood movement in the veins is relatively low compared to the arteries. The resulting thrombus can stay in the lumen of the vessel for a long time, partially blocking the blood flow, or it can come off and begin to migrate throughout the body. As a rule, the clot passes through the cavities of the heart and enters the pulmonary arteries, where it stops at the sites of bifurcation or narrowing of the vessel. As a result, a formidable and deadly condition develops – pulmonary embolism (PE).

Among the most common causes of thrombosis are damage to the vascular wall (including against the background of an inflammatory process, varicose veins), increased blood clotting, the presence of intravascular formations (adhesions, septa) or structures (stents, artificial valves). Risk factors include prolonged immobility, being overweight, smoking, pregnancy, and taking drugs that increase blood clotting.

Classification of venous thrombosis

Symptoms of thrombosis

Diagnosis

The diagnosis of the disease is carried out by a vascular surgeon. He collects the patient’s complaints and anamnesis, paying attention not only to the history of the appearance of specific symptoms, but also to possible background diseases and conditions (injuries, varicose veins, physical inactivity, taking oral contraceptives, etc.). Then, an examination of the lower extremities, palpation of the vessels, identification of areas of pain, etc. is carried out.

For preliminary detection of thrombosis, a marching test is performed: an elastic bandage is applied to the patient’s legs, after which he actively walks for some time, and then the bandage is removed. If in the process a person feels pain, and the veins under the bandage do not collapse, there is a blood clot inside the vessel.

The final diagnosis occurs after visualization of the clot and assessment of the condition of the vascular wall. For this it is used:

  • UZDG (duplex scanning) of the vessels of the limb;

  • rheovasography to assess the quality of microcirculation;

  • CT or MRI with contrast;

  • phlebography;

  • radioisotope scintigraphy, etc.

Additionally, blood tests are performed to detect inflammation, blood clotting (coagulogram) and other laboratory tests.

Vein thrombosis surgery

Treatment of vein thrombosis depends on the location and size of the affected vessel, the location of the thrombus itself, the severity of symptoms, the patient’s gender, age, the presence of risk factors and other factors. As a rule, the patient is hospitalized, and his condition is carefully monitored to avoid complications. With early diagnosis and a small number of risk factors, thrombolytic conservative therapy is allowed in combination with wearing compression underwear and lifestyle changes. With a high risk of thrombus separation and / or its large size, priority is given to surgical treatment methods.

Modern endovascular (intravascular) surgery allows operations to be performed with minimal tissue trauma. Depending on the situation, surgeons use:

Regional thrombolysis

The introduction of drugs that dissolve the thrombus directly to the clot using a catheter brought to the problem area.

Cava filter implantation

Installation of a special mesh inside the vessels, which will prevent a detached blood clot from entering other parts of the bloodstream.

More

Thrombectomy

The thrombus is removed through an incision in the vessel.

More

Vein plication

It is carried out when it is impossible to install a cava filter; the vessel is stitched with rare stitches that prevent the thrombus from passing further.

Expert opinion

Rehabilitation after surgery

Recovery time after surgery depends on the type of surgery. When using endovascular interventions, the patient remains under observation for 1-2 days, after which he is discharged home. During the recovery period, it is necessary to take all the drug prescribed by the doctor, wear special compression stockings, avoid physical activity, weight lifting, overheating, swimming in public or open water. As healing progresses, dosed physical activity (exercise therapy) and physiotherapy are prescribed.

FAQ

Yes, the process of bearing a child is one of the risk factors for the development of thrombosis.

No, with timely seeking help, doctors can dissolve the clot with the help of special preparations.

Sources

Peoples’ Friendship University of Russia

Department of Cardiology, X-ray endovascular and hybrid methods of diagnostics and treatment RUDN Institute.