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.

Deep Vein Thrombosis – OrthoInfo

Deep vein thrombosis, or DVT, occurs when a blood clot forms in one of the deep veins of the body. This can happen if a vein becomes damaged or if the blood flow within a vein slows down or stops. While there are a number of risk factors for developing a DVT, two of the most common are an injury to your lower body and surgery that involves your hips or legs.

A DVT can have serious consequences. If a blood clot breaks free, it may travel through the bloodstream and block blood flow to the lungs. Although rare, this complication—called a pulmonary embolism—can be fatal. Even if a blood clot does not break free, it may cause permanent damage to the valves in the vein. This damage can lead to long-term problems in the leg such as pain, swelling, and leg sores.

In many cases, DVT occurs without noticeable symptoms and is very difficult to detect. For this reason, doctors focus on preventing the development of DVT using different types of therapies, depending upon a patient’s needs. Your doctor will take steps to prevent DVT if you have a major fracture or are having lower extremity surgery—including total hip or total knee replacement.

Blood clots may form in one of the deep veins of the body. While DVT can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.

Arteries are the blood vessels that carry oxygen-rich blood from the heart to all other parts of the body. Veins return the oxygen-depleted blood back to the heart. There are two types of veins in the body:

• Superficial veins lie just below the skin’s surface
• Deep veins are located deep within the muscles

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms within one of the deep veins. While DVT can occur in any deep vein, it most commonly occurs in the veins of the pelvis, calf, or thigh.

Several factors can affect blood flow in the deep veins and increase the risk for developing blood clots. These include:

• Increasing age
• Personal or family history of DVT or pulmonary embolism
• Having cancer
• Having a vein disease, such as varicose veins
• Smoking
• Using birth control pills or hormone therapy
• Pregnancy
• Being overweight or obese
• Inheriting a blood-clotting disorder

A broken hip or leg, or having major surgery on your hip, knee or lower leg can affect normal blood flow and clotting. In these orthopaedic situations, three primary factors contribute to the formation of blood clots in veins: slow blood flow, hypercoagulation, and damage to the veins.

Blood that Flows Slowly through Veins (Stasis)

The walls of the veins are smooth. This helps blood flow freely and mix with naturally occurring agents (anticoagulants) in the blood that keep the blood cells from clotting. Blood that does not flow freely and does not mix with anticoagulants may be more likely to clot. This is why it is important to watch for signs of DVT in people who are on bed rest, immobilized in a splint or cast, or not able to move for long periods of time.

Hypercoagulation

Blood thickens, or coagulates, around matter that does not belong in the veins. During surgery, matter such as tissue debris, collagen, or fat may be released into the blood system and can cause the blood to coagulate. In addition, during total hip replacement, preparing the bone to receive the prosthesis may cause the body to release chemical substances called antigens into the blood system. These antigens can also stimulate clot formation.

Damage to the Vein Walls

During surgery, the doctor must move, or retract, soft tissues such as ligaments, muscles, and tendons to reach the area being operated on. In some cases, this can release naturally occurring substances that promote blood clotting.

Pulmonary Embolism

A pulmonary embolism is a blood clot that breaks free and travels through the veins. This can happen right after the formation of the blood clot or it may happen days later. If the blood clot reaches the lungs, it can block the flow of blood to the lungs and heart.

A pulmonary embolism is a serious medical emergency and can lead to death.

Post-thrombotic Syndrome

Some people who have a DVT develop long-term symptoms in the calf, a condition called post-thrombotic syndrome. Post-thrombotic syndrome is caused when damage to the veins results in venous hypertension—or higher than normal blood pressure in the veins. This increased pressure can damage the valves that control blood flow through the veins. This allows blood to pool at the site—sometimes causing lasting impairment.

Patients with post-thrombotic syndrome may experience symptoms that can impact their quality of life, including pain, swelling, skin changes, and leg sores.

Symptoms of DVT occur in the leg affected by the blood clot and include:

• Swelling
• Pain or tenderness
• Distended veins
• Red or discolored skin
• A firmness or thickening of the vein called a “cord”

Many patients, however, experience no symptoms at all.

In some cases, a pulmonary embolism may be the first sign of DVT. Symptoms of pulmonary embolism include:

• Shortness of breath
• Sudden onset of chest pain
• Coughing
• Spitting up or vomiting blood

If your doctor suspects DVT, he or she will order diagnostic tests.

Tests

Duplex ultrasound. This is the most common test for DVT. Ultrasound uses high-frequency sound waves that echo off the body—much like the technology used to check fetal well-being. This creates a picture of the blood vessels. Duplex ultrasound combines traditional ultrasound technology with Doppler technology, which generates a color image showing blood as it flows through the body.

Ultrasound is both noninvasive and painless. It can be repeated regularly because it does not require radiation. If you do not have a blood clot, duplex ultrasound may be helpful in revealing other causes for your symptoms.

(Left) In an ultrasound, the technician places a noninvasive probe called a “transducer” over the patient’s leg. (Right) The transducer sends images to the ultrasound machine and screen.

Magnetic resonance imaging (MRI) scan. An MRI produces detailed, cross-sectional images of structures inside the body, including blood vessels and veins. The test is painless and noninvasive. Although used infrequently, some doctors may use an MRI to locate blood clots in the pelvis and thigh.

MRI allows both legs to be viewed at the same time. However, it cannot be used for patients with certain implanted devices, such as pacemakers.

Venography. In venography, the doctor injects a contrast solution (or dye) into a vein. The solution mixes with the blood and flows throughout the veins. An x-ray of the affected leg will then show whether there are any blockages in the veins of the calf and thigh.

Venography is rarely used because it is invasive and requires radiation.

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Since DVT may occur after a major fracture or surgery, many patients are already hospitalized when the condition is diagnosed. The goals of treatment for DVT are to:

• Stop the blood clot from getting bigger
• Prevent the clot from breaking off and traveling to the lungs where it could lead to pulmonary embolism
• Reduce the chance of developing another clot
• Minimize the risk of developing other complications

Most often, treatment for DVT is nonsurgical.

Nonsurgical Treatment

Anticoagulants. Nonsurgical treatment usually consists of taking anticoagulants—blood thinning medications that will prevent further clotting and help dissolve existing clots. Anticoagulant medications are started immediately after the clot is diagnosed.

Anticoagulants can cause bleeding problems if the dosage is too high so their use must be monitored closely whether you are in the hospital or at home. Depending upon the medication you are taking, your doctor may order frequent blood tests to check how long it takes for your blood to clot. It is important to make sure that the medication level in your blood is high enough to prevent clots, but not too high to cause excessive bleeding.

The most common anticoagulants used to treat DVT are Xa inhibitors, heparin, low molecular weight heparin (LMWH),  and warfarin (Coumadin).

• Xa inhibitors. These newer anticoagulants are given orally. The are easy to administer, do not require blood test monitoring, and doses do not need to be adjusted.  Because of this, they are widely prescribed.

• Warfarin. Heparin or LMWH therapy is usually followed by 3 to 6 months of warfarin, which is taken orally. Warfarin takes at least 36 hours to start working, and from 4 to 5 days to reach its maximum effectiveness. For this reason, both heparin and warfarin are given at the start of treatment; the heparin protects the patient, keeping his or her blood anticoagulated until the warfarin “kicks in.”  Warfarin is less commonly used since the advent of Xa inhibitors because it requires frequent blood monitoring, while Xa inhibitors do not.

There are benefits and risks to all types of anticoagulants. Your doctor will talk with you about which medication will work best for you.

Observation and serial ultrasound. Depending on your individual risk factors, your doctor may manage an isolated, below the knee or calf DVT with observation and monitoring through serial duplex ultrasound scans, rather than anticoagulant therapy. Your doctor will discuss which type of treatment is right for you.

Thrombolytics. In some cases, your doctor may recommend using thrombolytics. These clot-dissolving medications are injected via a catheter directly into the blood clot and are used only when there is an extremely high risk for pulmonary embolism.

Surgical Treatment

If anticoagulants do not stop your blood clot from increasing in size, or if you have a medical condition that does not allow you to take anticoagulation medications, your doctor may recommend surgery to insert a small device called a vena cava filter into the main vein leading to your heart. This filter is designed to capture most blood clots traveling through your blood stream before they reach your lungs and cause a pulmonary embolism. In rare cases, surgery might be recommended to remove a blood clot from the veins or lungs.

If you are having orthopaedic surgery, your risk for developing DVT is highest from 2 to 10 days after surgery and includes the time after you have been discharged from the hospital. You remain at risk for about 3 months.

The measures your doctor uses to help prevent DVT are called prophylaxis. He or she will use several preventive measures in combination. For example, if you are having total knee or total hip replacement, your doctor may prescribe early movement and exercise, compression stockings, and medications that thin the blood and reduce the body’s ability to form blood clots.

Early Movement and Physical Therapy

Most patients begin walking or doing other leg exercises as soon as possible after surgery. Performing simple leg lifts while lying in bed will help increase blood flow through the veins. In addition, a physical therapist will teach you specific exercises to restore joint range of motion, strengthen your lower body, and improve circulation in your deep veins. If pain after surgery makes it difficult for you to move, you may be given pain medication so that you can move more comfortably.

Compression Devices

Graded elastic compression stockings are tight at the ankle and become looser as they go up the leg. The compression they provide may help circulation by preventing blood from pooling in the veins.

In addition, your doctor may recommend that you use an external pneumatic compression device after surgery. This device, which is worn like a boot, applies pulsing pressures to the calf. This pressure is similar to that which you experience while you are walking. Compression devices not only improve venous blood flow but also stimulate the body’s own ability to prevent blood clots.

A pneumatic compression device.

Anticoagulants

Anticoagulants, or blood thinners, are used to stop blood clots from getting bigger and to prevent new blood clots from forming. If you are having joint replacement surgery, you will start anticoagulants the day after surgery and continue in the hospital and at home. The length of time that you take the medication will vary, depending on the type of surgery you have had, as well as other risk factors.

Additional Measures

If you have experienced a traumatic lower body injury, you may be treated with additional prophylactic measures. Rarely, if you are unable to take anticoagulants, your doctor may recommend inserting a vena cava filter in the main vein leading to your heart. This is done to help prevent a potential DVT from reaching your heart and lungs and causing a pulmonary embolism.

Learn more: Preventing Blood Clots After Orthopaedic Surgery (Video)

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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 thromboses can also be divided by location:

• 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, treatment of thrombosis of the veins of the lower extremities, arteries (deep / superficial) – Department of Phlebology – NCC No. 2 (Central Clinical Hospital of the Russian Academy of Sciences) in Moscow

What is it?

Thrombosis is a pathological condition in which dense blood clots (thrombi) form in the vessels, slowing down or completely stopping the normal flow of blood. As a result, there may be a lack of nutrition of organs (ischemia), which in turn can lead to tissue death (necrosis, infarction) and death. There are two types of thrombosis: venous and arterial. From the names it is clear where the formation of blood clots occurs. In the first case – in the veins, in the second – in the arteries. The disease can occur in acute and chronic form. Arterial thrombosis is the most dangerous.

Main causes

There are three main factors for thrombus formation.

1. Damage to the vessel wall (as a result of trauma, surgery and malnutrition (cholesterol plaques form), infection, heavy lifting, childbirth, etc.).
2. Blood clotting disorder (tendency to increased clotting). Changes in blood clotting may occur due to metabolic disorders or hormonal imbalances.
3. Blood stasis . Occurs when a person remains motionless for a long time in one position (for example, in front of a computer, in an airplane seat or chained to a bed).

The risk group can also include people with varicose veins who are overweight, bad habits, leading a passive lifestyle, as well as people over 60 years old.

Symptoms of thrombosis

For arterial thrombosis, the following symptoms are characteristic:

• Sharp pain that occurs in one place and spreads to adjacent areas in the form of a pulsating stream
• Feeling of numbness of the extremities depending on the location of the thrombus, as a result of which they lose sensation and become cold
• Shortness of breath, irregular heartbeat, chest tightness (with obstruction of the pulmonary artery)
• Dizziness, speech disorder (with blockage of cerebral arteries)

At venous thrombosis is observed:

• Increasing pain in the affected area
• Swelling and thickening of the veins at the location of the thrombus
• The color of the skin in this place becomes blue
• Swelling and bulging of superficial veins.

Disease diagnosis

When contacting a medical institution, the doctor diagnoses and prescribes treatment. Main diagnostic methods:

• Blood clotting tests
• Magnetic resonance phlebography
• Duplex/triplex scanning of lower limb arteries
• Duplex/triplex lower extremity vein scanning
• Duplex/triplex scanning of extracranial brachiocephalic arteries
• Duplex/triplex scanning of intracranial brachiocephalic arteries
• Duplex/triplex scanning of arteries and veins of the upper extremities
• Ascending phlebography with contrast agent
• Radionuclide thrombus location scan
• Thromboelastography.

Professionals to contact:

• Phlebologist
• Vascular surgeon
• Cardiologist
• Neurologist and others

Treatment

Depending on the severity of the disease, conservative and surgical treatment is possible. With surgical intervention, the following is carried out: removal of blood clots, flashing of the vessel, ligation of the veins, arteriovenous shunting or other necessary operation.