Understanding Blood Clots | CDC

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Title: Stop The Clot, Spread The Word

Blood clots can affect anyone, and blood clots can be prevented.

On average, one American dies of a blood clot every 6 minutes.

Understanding Blood Clots

A blood clot in one of the large veins, usually in a person’s leg or arm, is called a deep vein thrombosis or DVT. When a blood clot like this forms, it can partly or completely block the flow of blood through the vein.

If a DVT is not treated, it can move or break off and travel to the lungs.

A blood clot in the lung is called pulmonary embolism or PE, and can cause death and requires immediate medical attention.

Know Your Risks

Blood clots do not discriminate by age, gender, ethnicity or race. Blood clots can affect anyone. Three major risk factors are:

• Cancer
• Hospitalization & Surgery
• Pregnancy

Other Risk Factors Include:

• Birth control that contains estrogen
• Being overweight
• Hormone replacement therapy that contains estrogen
• Family history of blood clots
• Trauma, particularly when the vein is injured
• Smoking
• Immobility or sitting for long periods

Recognize The Signs And Symptoms

Blood clots can be safely treated.

DVT (Arm or Leg) – if you experience any of these, call your doctor as soon as possible.

• Swelling of your leg or arm
• Pain or tenderness not caused by an injury
• Skin that is warm to the touch, with swelling or pain
• Redness of the skin, with swelling or pain

PE (Lung) – if you experience any of these, seek medical attention immediately.

• Difficulty breathing
• Chest pain that worsens with a deep breath
• Coughing up blood
• Faster than normal or irregular heartbeat

Blood Clots Can Be Prevented

• Know your risks and recognize signs and symptoms.
• Tell your doctor if you have risk factors for blood clots.
• Before any surgery, talk with your doctor about blood clots.
• See your doctor as soon as you can if you do have any symptoms.

To learn more about blood clots and to spread the word, visit stoptheclot.org/spreadthewordexternal icon

First Signs of Deep Vein Thrombosis: Premier Vein & Vascular: Vascular and Endovascular Surgery

Deep vein thrombosis (DVT) happens when a thrombus (blood clot) forms in a vein that is located deep inside the body. The most common place for DVT to happen is in the legs.

While DVT can cause minor symptoms or no symptoms at all, some patients experience pain or swelling in the leg.

Risk Factors of Developing DVT

Some people are more likely to develop DVT than others because of existing medical conditions. Below are some examples of things that can make a person more prone to DVT:

• Prolonged bed rest – When the body doesn’t move very much, or if a person has to stay in bed for a long time.
• Blood-clotting disorders – Individuals with disorders that cause their blood to clot faster and more often.
• Injury – An injury to veins due to an accident or surgery.
• Obesity – Obesity increases the pressure on the pelvis, legs, and veins.
• Smoking – Smoking can also cause blood clotting and circulation problems in the body.
• Heart failure – Heart failure can increase a person’s chances of developing DVT and pulmonary embolism.

Symptoms of Deep Vein Thrombosis

One of the problems in diagnosing DVT is that many people develop the condition without any symptoms. This usually makes the condition go undetected for a very long time.

Individuals who do begin to experience DVT symptoms may experience the following issues:

• Pain – A common symptom for DVT is pain the calf. It can feel like cramping or a soreness in the leg.
• Discolored skin – Another common symptom of DVT is discoloration of the skin on the leg. Most commonly, individuals see redness on the leg in which DVT has occurred.
• Warm sensation – Feeling a warm sensation is also a DVT symptom. One leg feels warmer to the touch, or warmth can be felt coming from the leg. 

Warning Signs of DVT and Pulmonary Embolism

Sometimes, DVT can cause a life-threatening complication called a pulmonary embolism. If you experience any of the symptoms of DVT listed above, you should see a doctor.

However, if you experience any of the following warning symptoms of a pulmonary embolism, you should seek medical attention immediately:

• Rapid pulse
• Lightheadedness or fainting
• Chest pain that worsens when you take deep breaths
• Sudden shortness of breath

How to Prevent DVT

While it is impossible to completely prevent DVT from ever happening, there are steps you can take to decrease your chance of developing it. They include:

• Exercising regularly to reduce your risk of blood clots
• Avoiding sitting still for long periods of time
• Losing weight
• Quitting smoking

DVT Physicians in the Tampa Bay Area

Premier Vein & Vascular offers three locations to serve you in Tampa, Largo, and Lakeland. Our team excels in the diagnosis, treatment, and prevention of vascular and vein conditions, including deep vein thrombosis and blood clots.

If these types of issues are causing you physical or emotional distress, call us today to make an appointment at (888) VEINCARE (834-6227) or request a consultation online. Let us explain how we can help you resolve the problem quickly and painlessly.

Deep Vein Thrombosis (DVT) – Vascular Cures

What is Deep Vein Thrombosis (DVT)?

Deep vein thrombosis, commonly referred to as “DVT,” occurs when a blood clot or thrombus, develops in the large veins of the legs or pelvic area. Some DVTs may cause no pain, whereas others can be quite painful. With prompt diagnosis and treatment, the majority of DVTs are not life threatening. However, a blood clot that forms in the invisible “deep veins” can be life threatening. A clot that forms in the large, deep veins is more likely to break free and travel through the vein. It is then called an embolus. When an embolus travels from the legs or pelvic areas and lodges in a lung artery, the condition is known as a “pulmonary embolism,” or PE, a potentially fatal condition if not immediately diagnosed and treated.

Symptoms

Approximately one-half of those with a DVT never have recognizable symptoms. The most common symptom is leg pain and tenderness in the calf muscles. One may also observe swelling or a change in color of one leg to purple or blue. These signs and symptoms may appear suddenly or may steadily develop over a short period of time. If you observe these signs or symptoms, you should contact your doctor immediately.

Symptoms are quite different if the clot breaks loose and travels to the lungs, causing a pulmonary embolism (PE). The symptoms of PE include chest pain, shortness of breath, rapid pulse, or a cough. There may also be a feeling of apprehension, sweating, or fainting. Such symptoms are not specific to a PE, and can occur with pneumonia, heart attack, and other medical conditions.

These are always critical symptoms that demand immediate medical attention.

Most common Signs and Symptoms of DVT

These symptoms can develop slowly or suddenly. If you have any of these symptoms, contact your doctor immediately.

• Sudden swelling of one limb
• Pain or tenderness
• Skin that is warm to the touch
• Fullness of the veins just beneath the skin
• Change in color (blue, red or very pale)

Common Signs and Symptoms of PE

PE can be fatal, if you experience these signs or symptoms seek medical attention right away.

• Shortness of breath
• Sudden chest pain
• A feeling of apprehension
• Sudden collapse
• Coughing
• Sweating
• Blood phlegm (coughing up blood)

The signs and symptoms of these disorders (DVT and PE) can vary by individual and event. Some individuals may also experience uncommon symptoms such as dizziness, back pain or wheezing.

Diagnosis

DVT is diagnosed by an ultrasound exam. This simple, painless test is safe and widely available. A specific blood test may also be performed to measure “D-dimer” which is a sign of recent clotting. When this test is negative, it is unlikely that DVT has occurred.

Causes

DVT is generally caused by a combination of two or three underlying conditions:

• Slow or sluggish blood flow through a deep vein
• Tendency for a person’s blood to clot quickly
• Irritation, inflammation or injury to the inner lining of the vein

There are a variety of settings in which this abnormal clotting process can occur. These include individuals on bed rest (such as during or after a surgical procedure or medical illness, like heart attack or stroke) or those who are confined and unable to walk for prolonged periods of time (such as during prolonged air or car travel). It can occur in certain families where there is a history of parents or siblings who have suffered from prior blood clots. It can also occur in individuals with active cancer or those undergoing cancer treatment which may predispose the blood to clotting.

Having a recent major surgical procedure, especially hip and knee orthopedic surgeries or one that requires prolonged bed rest, predispose the blood to clotting. Irritation or inflammation occurs when a leg vein is injured by a major accident or medical procedure.

Also, there are specific medical conditions that may increase your risk of developing a DVT via these three mechanisms, such as congestive heart failure, severe obesity, chronic respiratory failure, a history of smoking, varicose veins, pregnancy and estrogen treatment. If you are concerned that you may be at risk, please consult with your health care provider.

Treatment

Both DVT and PE are treated with blood thinning medication. These medicines, called anticoagulants, decrease your blood’s ability to clot and can also stop clots from getting bigger. The use of medication may also prevent new clots from forming. They do not, however, break up existing clots that have already formed. The body’s natural systems will help dissolve the clot to varying degrees.

Sometimes patients with DVT are also asked to wear a prescription stocking to help treat the symptoms of swelling and prevent skin changes that can occur over time from the damage to the vein from the DVT. Skin changes can include dermatitis, skin discoloration, scarring and ulcers. This condition is called “post-thrombotic syndrome.” Stockings and devices that use air pressure to inflate long leg cuffs are also used for the prevention of DVT.

Some health care providers may recommend sequential compression devices to promote blood flow. Anticoagulant therapy helps to prevent clots from forming and diminishes the risk of a pulmonary embolus. It consists of heparin, which may be given intravenously or, more frequently, by subcutaneous injection, followed by warfarin, which can be given orally and continued on an outpatient basis.

The health care providers may also recommend thrombolysis, using an intravenous agent that dissolves clots. With this procedure, a catheter is threaded up through the clot, and one of the clot-dissolving drugs is injected to dissolve it. The clotbuster is injected slowly through a catheter with many tiny holes into the area of the DVT, much like a soaker hose. Sometimes a tiny vacuum cleaner is used to suck out the softened clot. Once the clot is gone, balloon angioplasty or stenting may be necessary to open the narrowed vein, but this is common only in the iliac veins, located in the pelvic area. With this approach, the patient will also need anticoagulant medication (heparin) to prevent new blood clot formation while the existing clot is being dissolved.

For a few patients who have valid reasons for clot removal but for whom clot-dissolving drugs cannot be used, extraction of the clot, through a small incision at the groin, may be recommended. Both approaches are designed to remove the clot and restore the venous system to normal, but they involve additional risk and expense and therefore are applied selectively by the appropriate vascular specialist. Clot removal, by either technique, is usually recommended only for major clots higher up in the leg, and particularly in active, healthy patients without any serious associated diseases. It can significantly reduce the serious late after effects of DVT, such as chronic leg swelling, discoloration, and ultimately, ankle ulcers, but they do so at an increased risk of serious bleeding.

Some Tips to Avoid DVT

• Do not sit for long periods of time
• Elevate legs if you are sitting for moderate periods of me
• If you are on an airplane for more than four hours, get up and walk in the aisles, pump your feet up and down
• If you are flying, drink plenty of non-alcoholic beverages
• Keep hydrated – drink six glasses of water a day
• Talk to your doctor about the need for medications or graduated elastic compression stockings for long airplane flights
• If you have varicose veins, wear support hose (especially if pregnant)
• Do not wear constricting garments around the legs or waist (elastic bands or garters)

What are warning signs of blood clots?

Here’s what you need to know about blood clots.

A blood clot can be a serious medical problem. It can even lead to a heart attack, stroke or death. In fact, 274 people die every day from blood clots, according to the National Blood Clot Alliance.

So what does a blood clot look or feel like? And how do you know if you have one?

A blood clot is a gel-like collection of blood cells in the veins or arteries that blocks blood flow. Without proper blood flow, important parts of your body like the heart, brain and legs may not get the oxygen they need. Blood clots can be as small as a grain of rice or as long as a Polish kielbasa, says Dr. Lawrence “Rusty” Hofmann, a professor of interventional radiology at Stanford University Medical Center in Palo Alto, California.

Types of Blood Clots

Millions of years ago, blood clots helped stop humans from bleeding to death after they were bitten by saber-tooth tigers, Hofmann explains. Nowadays, blood clots can still be helpful if we get injured, but they also can form for other reasons, which can be harmful.

The three types of venous blood clots are:

1. Superficial thrombophlebitis. This is the least serious type of blood clot. It forms in a vein near the skin’s surface. Although it’s less harmful, this type of clot should still be checked out by a doctor as it sometimes leads to deep vein thrombosis.

2. Deep vein thrombosis. Also called DVT, this type of blood clot occurs when a clot forms deep inside a vein, usually in the arms or legs.

3. Pulmonary embolism.

In discussions of blood clots, you might also hear the term arterial clots. These are different conditions with different implications depending on where they occur.

What worries doctors the most is when a blood clot in one part of your body — say, your leg — dislodges and travels to the brain, heart or lungs, says Dr. Nicole Weinberg, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California.

In the lungs, a blood clot can cause what’s called a pulmonary embolism. According to the Centers for Disease Control and Prevention, 25% of people with a pulmonary embolism die without warning. Pulmonary embolisms are the leading cause of death in those with cancer, aside the cancer itself.

[Read: Exercising Safely After Having a Blood Clot.]

Risk Factors for a Blood Clot

There are several risk factors that put someone at a higher risk for a blood clot, including the following:

— You’re pregnant.

— You use birth control pills or hormone therapy.

— You’re obese.

— You smoke.

— You have diabetes.

— You’re over the age of 60.

— You’re inactive for a long time. For example, you have a sedentary lifestyle, or you’re resting at home after surgery.

— You’ve had orthopedic surgery.

— You have or recently had COVID-19.

— You’re traveling for a long time in a plane, car or train, and you’re not able to move around much.

— You have certain blood disorders, such as Factor V Leiden, that make you more prone to clotting.

— You have the autoimmune disorder antiphospholipid syndrome or lupus.

— You have cancer.

Doctors usually believe that two factors often come together to increase the risk for blood clotting, says Dr. Jack F. Jacoub, an internist, hematologist and medical oncologist with MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, California.

For example, you have cancer, and you’re on treatment and doing well. You decide with your family to travel to Hawaii. The combination of having cancer and taking a long trip may increase your risk, Jacoub says.

Another example: You’re a young woman who’s pregnant, and you’re on a long business trip. “All of the sudden you could be dealing with a really big crisis in someone who’s supposed to be healthy,” Weinberg says.

Researchers are still exploring the link between COVID-19 and blood clots and whether there’s a continued blood clot risk for a certain time period after having the virus. One thing they do know is that COVID-19 can directly affect blood vessels, and that increases the risk of blood clots, says Dr. Ian Del Conde-Pozzi, a cardiologist and vascular medicine specialist with Baptist Health’s Miami Cardiac & Vascular Institute.

[READ: Exercise and Virtual Reality.]

Symptoms of a Blood Clot

Blood clots can have several symptoms, although sometimes they’re not obvious. The symptoms may vary depending on where the blood clot is located. They can come on suddenly and then get worse fairly quickly.

For deep vein thrombosis, symptoms at the site of the clot include:

— Redness.

— Warmth at the skin.

— Pain that’s not caused by an injury.

— Swelling.

— A cramp-like or charley horse feeling.

For a pulmonary embolism, symptoms include:

— Unexplained shortness of breath.

— An unexplained cough.

— A faster heart rate.

— Chest pain.

— Feeling fatigued or not like yourself.

You have to stay aware of how serious these symptoms can be. “It’s important, especially in young, healthy patients who don’t think of themselves at risk,” says Dr. Danielle R. Bajakian, an assistant professor of surgery with Columbia University Medical Center in New York.

She’s seen several young adults with blood clots in their legs, and they assumed their symptoms were from working too hard at the gym. They ignored the symptoms until they went from mildly annoying to extremely serious or painful.

It’s especially important to seek medical attention quickly for a suspected blood clot if you’ve recently taken a long trip, Jacoub says.

Blood Clots and COVID-19 Vaccines

A rare type of blood clot sometimes forms in those having the Johnson & Johnson COVID-19 vaccine. This risk is not associated with the Pfizer-BioNTech or Moderna vaccine. The AstraZeneca vaccine also has been associated with a blood clotting risk but is not currently available in the U. S.

Called vaccine-induced thrombotic thrombocytopenia or thrombosis with thrombocytopenia syndrome, these rare blood clots occurred in 28 people after 8.7 million doses of the Johnson & Johnson vaccine were given in the U.S. through mid-May 2021. As of mid-May, three people had died from the blood clots. Those who have experienced these blood clots tend to be under age 50 and female.

The cause of these clots is different from the other types of clots typically seen in medicine, Del Conde-Pozzi says. The clots appear to be related to an immune reaction where antibodies, or proteins that help fight invaders to the body, develop against a type of blood protein called platelet factor 4. People with the clots also have low counts of a type of blood clotting cell called platelets. The blood clots that occur happen in less common areas of the body, such as the veins in the brain or veins in the abdomen.

It may be that the delivery systems used in these vaccines cause this abnormal clotting, says Dr. Aloke Finn, an interventional cardiologist and associate professor of medicine at the University of Maryland School of Medicine in Baltimore.

The symptoms of the vaccine-related blood clot are similar to other blood clots and include:

— A bad headache.

— Bleeding.

— Leg swelling.

— Shortness of breath.

— Significant abdominal pain.

The symptoms will occur within five days to a month after receiving the vaccine. Symptoms that occur within a day or two after your vaccine, such as a fever, fatigue or mild headache, are normal and don’t indicate this rare blood clot, Finn says.

As with other blood clots, you should go to the emergency room if you have these symptoms. Let those treating you know if you had the Johnson & Johnson vaccine. Treatment will usually include a specific type of blood thinner, high doses of a treatment called intravenous immunoglobulin and steroids in some cases.

While it’s always a good idea to talk with your doctor about the best vaccine for you, the benefit of the vaccine generally outweighs the risks, Del Conde-Pozzi says. For instance, the Johnson & Johnson vaccine is one dose, and that could be easier for some people. Plus, the incidence of this rare type of blood clot is still low compared with the number of doses given throughout the U.S.

Treatment for Blood Clots

If you suspect you or someone you’re with has a blood clot, seek medical attention right away. If your symptoms happen on a Friday night, don’t wait until Monday morning to call your doctor. Go to the ER. Even some urgent care offices have the technology to diagnose a blood clot.

The two major treatments for blood clots are medicines or the use of special devices, such as wires and catheters, to help open the blood vessels, Hofmann says. Blood thinners are the most common type of medicine used to treat blood clots. The medicines used may be given orally or through an IV. Doctors might perform a surgical procedure called a thrombectomy to try to remove a clot.

For heart attacks or strokes related to a blood clot, you may receive thrombolytic therapy. This involves the use of drugs that can help break up the clot. Breaking up the clot is needed so you no longer have the clot blocking blood flow.

The treatments for blood clots are generally effective. However, more serious blood clots can lead to death, even once a patient is in the emergency room, Jacoub says. That can happen because a person may not get to the ER quickly enough.

“The smaller the clot is, the more you can prevent further destruction,” Weinberg says.

For people who have chronic problems with blood clots, there are special stents — a tiny tube inserted into the blood vessel to help keep it open — available to help them, Hofmann says.

[SEE: How to Describe Medical Symptoms to Your Doctor.]

Blood Clot Prevention

There are some things you can do to lower your risk for blood clots.

1. Know your risk.

Talk to your doctor about your risk for blot clots. If you’re at a higher risk and about to do something that will increase the chances of a blood clot forming — for example, take a long flight — your doctor may recommend that you use blood thinners in advance to lower your risk. A long flight can be eight hours or more, but you still would want to stay active on a flight that’s three hours or more.

2. Before a major surgery or hospital stay, ask your doctor what they’ll do to lower your risk for blood clots.

For instance, patients who have been in the hospital for three or four days or who have certain orthopedic procedures like hip replacement surgery typically receive blood thinners to reduce their clotting risk, Del Conde- Pozzi says.

One drawback of blood thinners is they could cause increased bleeding, although the medications continue to improve in this area, Finn says. Your doctor will weigh the risks and benefits of prescribing a blood thinner as needed, he adds.

3. Aim for overall healthy habits.

Stay physically active and don’t smoke. The increased risk of blood clots is yet another reason to quit the smoking habit, Bajakian says.

4. Work with your health care providers to get back on your feet promptly after surgery.

This will help you not be too sedentary, which could increase your risk for blood clots.

5. If you sit a lot with your job, get up every hour or two to walk around or stretch.

6. Keep any chronic health conditions, such as diabetes or high blood pressure, under control.

7. Take special precautions when you’re on a long trip.

Stay hydrated by drinking lots of water and avoiding alcohol. Consider wearing compression stockings, which are used around the legs to help prevent vein disorders. These types of stockings are designed to lengthen the calf and help blood flow out of the legs and back to the heart.

Get up and walk every hour or so. If that’s not possible — we hear you, window seat traveler — you can still do some simple exercises to keep your calves active.

Hofmann recommends pushing your toes down and then lifting your heels off the ground. Do this 20 times every hour. To help stay active and reduce the risk for blood clots, passengers on a 2019 flight on Qantas Airlines from New York to Sydney, Australia, did the “Macarena” around the plane to keep moving, according to news reports.

By taking steps to cut your risk of blood clots, you can help prevent a serious health issue.

More from U.S. News

9 Reasons You Should Return to Work After a Stroke

Questions Doctors Wish Their Patients Would Ask

7 Ways to Prevent Medical Errors

What Are the Warning Signs of a Blood Clot? originally appeared on usnews.com

Update 08/06/21: This piece was previously published at an earlier date and has been updated with new information.

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Pulmonary Embolism | HealthLink BC

Topic Overview

What is pulmonary embolism?

Pulmonary embolism is the sudden blockage of a major blood vessel (artery) in the lung, usually by a blood clot. In most cases, the clots are small and are not deadly, but they can damage the lung. But if the clot is large and stops blood flow to the lung, it can be deadly. Quick treatment could save your life or reduce the risk of future problems.

What are the symptoms?

The most common symptoms are:

• Sudden shortness of breath.
• Sharp chest pain that is worse when you cough or take a deep breath.
• A cough that brings up pink, foamy mucus.

Pulmonary embolism can also cause more general symptoms. For example, you may feel anxious or on edge, sweat a lot, feel light-headed or faint, or have a fast heart rate or palpitations.

If you have symptoms like these, you need to see a doctor right away, especially if they are sudden and severe.

What causes pulmonary embolism?

In most cases, pulmonary embolism is caused by a blood clot in the leg that breaks loose and travels to the lungs. A blood clot in a vein close to the skin is not likely to cause problems. But having blood clots in deep veins (deep vein thrombosis) can lead to pulmonary embolism. In the United States, more than 300,000 people each year have deep vein thrombosis or a pulmonary embolism.^{footnote 1}

Other things can block an artery, such as tumours, air bubbles, amniotic fluid, or fat that is released into the blood vessels when a bone is broken. But these are rare.

What increases your risk of pulmonary embolism?

Anything that makes you more likely to form blood clots increases your risk of pulmonary embolism. Some people are born with blood that clots too quickly. Other things that can increase your risk include:

• Being inactive for long periods. This can happen when you have to stay in bed after surgery or a serious illness, or when you sit for a long time on a flight or car trip.
• Recent surgery that involved the legs, hips, belly, or brain.
• Some diseases, such as cancer, heart failure, stroke, or a severe infection.
• Pregnancy and childbirth (especially if you had a caesarean section).
• Taking birth control pills or hormone therapy.
• Smoking.

You are also at higher risk for blood clots if you are an older adult (especially older than 70) or extremely overweight (obese).

How is pulmonary embolism diagnosed?

It may be hard to diagnose pulmonary embolism, because the symptoms are like those of many other problems, such as a heart attack, a panic attack, or pneumonia. A doctor will start by doing a physical examination and asking questions about your past health and your symptoms. This helps the doctor decide if you are at high risk for pulmonary embolism.

Based on your risk, you might have tests to look for blood clots or rule out other causes of your symptoms. Tests may include blood tests, CT angiogram, and a ventilation-perfusion lung scan.

How is it treated?

Doctors usually treat pulmonary embolism with medicines called anticoagulants. They are often called blood thinners, but they don’t really thin the blood. They help prevent new clots and keep existing clots from growing.

Most people take a blood thinner for a few months. People at high risk for blood clots may need it for the rest of their lives.

If symptoms are severe and life-threatening, “clot-busting” drugs called thrombolytics may be used. These medicines can dissolve clots quickly, but they increase the risk of serious bleeding. Another option is surgery or a minimally invasive procedure to remove the clot (embolectomy).

Some people may have a filter put into the large vein (vena cava) that carries blood from the lower body to the heart. A vena cava filter helps keep blood clots from reaching the lungs.

If you have had pulmonary embolism once, you are more likely to have it again. Blood thinners can help reduce your risk, but they increase your risk of bleeding. If your doctor prescribes blood thinners, be sure you understand how to take your medicine safely.

You can reduce your risk of pulmonary embolism by doing things that help prevent blood clots in your legs.

• Avoid sitting for long periods. Get up and walk around every hour or so, or flex your feet often.
• Get moving as soon as you can after surgery.
• Wear compression stockings if you are at high risk.
• If you take blood thinners, take them just the way your doctor tells you to.

Cause

Pulmonary embolism is caused by a blocked artery in the lungs. The most common cause of such a blockage is a blood clot that forms in a deep vein in the leg and travels to the lungs, where it becomes lodged in a smaller lung artery.

Almost all blood clots that cause pulmonary embolism are formed in the deep leg veins. Clots also can form in the deep veins of the arms or pelvis.

Sometimes blood clots develop in surface veins. But these clots rarely lead to pulmonary embolism.

In rare cases, pulmonary embolism may be caused by other substances, including:

• Small masses of infectious material.
• Fat, which can be released into the bloodstream after some types of bone fractures, surgery, trauma, or severe burns.
• Air bubbles or substances that get into the blood from trauma, surgery, or medical procedures.
• Tumours caused by rapidly growing cancer cells.

Symptoms

The symptoms of pulmonary embolism may include:

• Shortness of breath that may occur suddenly.
• Sudden, sharp chest pain that may become worse with deep breathing or coughing.
• Rapid heart rate.
• Rapid breathing.
• Sweating.
• Anxiety.
• Coughing up blood or pink, foamy mucus.
• Fainting.
• Heart palpitations.
• Signs of shock.

Pulmonary embolism may be hard to diagnose because its symptoms may occur with or are similar to other conditions, such as a heart attack, asthma, a panic attack, or pneumonia. Also, some people with pulmonary embolism don’t have symptoms.

What Happens

If a large blood clot blocks the artery in the lung, blood flow may be completely stopped, causing sudden death. A smaller clot reduces the blood flow and may cause damage to lung tissue. But if the clot dissolves on its own, it may not cause any major problems.

Symptoms of pulmonary embolism usually begin suddenly. Reduced blood flow to one or both lungs can cause shortness of breath and a rapid heart rate. Inflammation of the tissue covering the lungs and chest wall (pleura) can cause sharp chest pain.

Without treatment, pulmonary embolism is likely to come back.

Complications of pulmonary embolism

• Cardiac arrest and sudden death
• Shock
• Abnormal heart rhythms
• Death of part of the lung, called pulmonary infarction
• A buildup of fluid (pleural effusion) between the outside lining of the lungs and the inner lining of the chest cavity
• Paradoxical embolism
• Pulmonary hypertension

Doctors will consider aggressive steps when they are treating a large, life-threatening pulmonary embolism.

Chronic or recurring pulmonary embolism

Blood clots that cause pulmonary embolism may dissolve on their own. But if you have had pulmonary embolism, you have an increased risk of a repeat episode if you do not receive treatment. If pulmonary embolism is diagnosed promptly, treatment with anticoagulant medicines may prevent new blood clots from forming.

The risk of having another pulmonary embolism caused by something other than blood clots varies. Substances that are reabsorbed into the body, such as air, fat, or amniotic fluid, usually do not increase the risk of having another episode. Cancer increases the risk of blood clots.

Having multiple episodes of pulmonary embolism can severely reduce blood flow through the lungs and heart. Over time, this increases blood pressure in the lungs (pulmonary hypertension), eventually leading to right-sided heart failure and possibly death.

What Increases Your Risk

Having a blood clot in the deep vein of your leg and having a previous pulmonary embolism are the two greatest risk factors for pulmonary embolism.

For more information on risk factors for blood clots in the legs, see the topic Deep Vein Thrombosis.

Many things increase your risk for a blood clot. These include:

• Having slowed blood flow, abnormal clotting, and a blood vessel injury.
• Age. As people get older (especially older than age 70), they are more likely to develop blood clots.
• Weight. Being overweight increases the risk for developing clots.
• Not taking anticoagulant medicine as prescribed, unless your doctor tells you to stop taking it.

Slowed blood flow

When blood does not circulate normally, clots are more likely to develop. Reduced circulation may result from:

• Long-term bedrest, such as if you are confined to bed after an operation, injury, or serious illness.
• Travelling and sitting for a long time, especially when travelling long distances by airplane.
• Leg paralysis. When you use your muscles, the muscles contract, and that squeezes the blood vessels in and around the muscles. The squeezing helps the blood move back toward the heart. Paralysis can reduce circulation because the muscles can’t contract.

Abnormal clotting

Some people have blood that clots too easily or too quickly. People with this problem are more likely to form larger clots that can break loose and travel to the lungs. Conditions that may cause increased clotting include:

• Inherited factors. Some people have an inherited tendency to develop blood clots that can lead to pulmonary embolism.
• Family history of close relatives, such as a sibling, who has had deep vein thrombosis or pulmonary embolism.
• Cancer and its treatment.
• Blood vessel diseases, such as varicose veins, heart attack, heart failure, or a stroke.
• Pregnancy. A woman’s risk for developing blood clots increases both during pregnancy and shortly after delivery.
• Using hormone therapy or birth control pills or patches.
• Smoking.

Injury to the blood vessel wall

Blood is more likely to clot in veins and arteries shortly after they are injured. Injury to a vein can be caused by:

• Recent surgery that involved the legs, hips, belly, or brain.
• A tube (catheter) placed in a large vein of the body (central venous catheter).
• Damage from an injury, such as a broken hip, serious burn, or serious infection.

When should you call your doctor?

Call
911
or other emergency services immediately if you think you have symptoms of pulmonary embolism.

Symptoms include:

• Sudden shortness of breath.
• Sharp chest pain that sometimes becomes worse with deep breathing or coughing.
• Coughing up blood.
• Fainting.
• Rapid pulse or irregular heartbeat.
• Anxiety or sweating.

Call your doctor immediately if you have symptoms of a blood clot in the leg, including:

• Swelling, warmth, or tenderness in the soft tissues of your leg. Swelling may also appear as a swollen ridge along a blood vessel that you can feel.
• Pain in your leg that gets worse when you stand or walk. This is especially important if there is also swelling or redness in your leg.

Blood clots in the deep veins of the leg are the most common cause of pulmonary embolism. For more information on these types of blood clots, see the topic Deep Vein Thrombosis.

Who to see

Your family doctor, general practitioner, or an emergency room doctor can diagnose pulmonary embolism. Your doctor may refer you to a respirologist, cardiologist, or hematologist for further testing and treatment.

Examinations and Tests

Diagnosing pulmonary embolism is difficult, because there are many other medical conditions, such as a heart attack or an anxiety attack, that can cause similar symptoms.

Diagnosis depends on an accurate and thorough medical history and ruling out other conditions. Your doctor will need to know about your symptoms and risk factors for pulmonary embolism. This information, combined with a careful physical examination, will point to the initial tests that are best suited to diagnose a deep vein thrombosis or pulmonary embolism.

Tests that are often done if you have shortness of breath or chest pain include:

• A chest X-ray. Results may rule out an enlarged heart or pneumonia as a cause of your symptoms. If the chest X-ray is normal, you may need further testing.
• Electrocardiogram (EKG, ECG). The electrical activity of the heart is recorded with this test. EKG results will help rule out a possible heart attack.

Further testing may include:

• D-dimer. A D-dimer blood test measures a substance that is released when a blood clot breaks up. D-dimer levels are usually high in people with pulmonary embolism.
• CT (computed tomography) scan or CT angiogram. These tests might be done to look for a pulmonary embolism or for a blood clot that may cause a pulmonary embolism.
• Magnetic resonance imaging (MRI). This test may be used to view clots in the lungs.
• Doppler ultrasound. A Doppler ultrasound test uses reflected sound waves to determine whether a blood clot is present in the large veins of the legs.
• Echocardiogram (echo). This test detects abnormalities in the size or function of the heart’s right ventricle, which may be a sign of pulmonary embolism.
• Ventilation-perfusion scanning. This test scans for abnormal blood flow through the lungs after a radioactive tracer has been injected and you breathe a radioactive gas.
• Pulmonary angiogram. This invasive test is done only in rare cases to diagnose pulmonary embolism.

After your doctor has determined that you have a pulmonary embolism, other tests can help guide treatment and suggest how well you will recover. These tests may include:

• A blood test to check the level of the hormone brain natriuretic peptide (BNP). Higher levels of BNP mean your heart is under increased stress.
• A blood test to look at the level of the protein troponin. Higher levels of troponin can mean there is damage to your heart muscle.

Treatment Overview

Treatment of pulmonary embolism focuses on preventing future pulmonary embolism by using anticoagulant medicines. Anticoagulants prevent existing blood clots from growing larger and help prevent new ones from developing.

If symptoms are severe and life-threatening, immediate and sometimes aggressive treatment is needed. Aggressive treatment may include thrombolytic medicines, which can dissolve a blood clot quickly but also increase the risk of severe bleeding. Another option for life-threatening, large pulmonary embolism is to remove the clot. This is called an embolectomy. An embolectomy is done during a surgery or minimally invasive procedure.

Some people may also benefit from having a vena cava filter inserted into the large central vein of the body. This filter can help prevent blood clots from reaching the lungs. This filter might be used if you have problems taking an anticoagulant.

Prevention

Daily use of anticoagulant medicines may help prevent recurring pulmonary embolism by stopping new blood clots from forming and stopping existing clots from growing.

The risk of forming another blood clot is highest in the weeks after the first episode of pulmonary embolism. This risk decreases over time. But the risk remains high for months and sometimes years, depending upon what caused the pulmonary embolism. People with recurrent blood clots and/or pulmonary embolism may have to take anticoagulants daily for the rest of their lives. Anticoagulant medicines also are often used for people who are not active due to illness or injury, or people who are having surgery on the legs, hips, belly, or brain.

Other preventive methods may also be used, such as:

• Getting you moving shortly after surgery.
• Wearing compression stockings to help prevent leg deep vein thrombosis if you are at increased risk for this condition.

Take steps to prevent blood clots from travel, such as walking around every hour. Because of long periods of inactivity, you are at higher risk for blood clots when you are travelling.

If you are already at high risk for pulmonary embolism or deep vein thrombosis, talk to your doctor before taking a long flight or car trip. Ask if you need to take any special precautions to prevent blood clots during travel.

Home Treatment

Home treatment is not recommended for initial treatment for pulmonary embolism. But it is important for preventing more clots from developing and causing a deep vein thrombosis, which can lead to recurring pulmonary embolism.

Measures that reduce your risk for developing a deep vein thrombosis include the following:

• Take anticoagulant medicines exactly as prescribed.
• Exercise. Keep blood moving in your legs by pointing your toes up toward your head so that your calves are stretched, then relaxing. Repeat. This exercise is especially important when you are sitting for long periods of time, for example, on long driving trips or airplane flights.
• Get up out of bed as soon as possible after an illness or surgery. It is very important to get moving as soon as you are able. If you cannot get out of bed, do the leg exercises described above every hour to keep the blood moving through your legs.
• Quit smoking.
• Wear compression stockings to help prevent leg deep vein thrombosis if you are at increased risk for this condition.

Medications

Medicines can help prevent repeated episodes of pulmonary embolism by preventing new blood clots from forming or preventing existing clots from getting larger.

Anticoagulants

Anticoagulants are prescribed when pulmonary embolism is diagnosed or strongly suspected.

You’ll likely take an anticoagulant for at least 3 months after pulmonary embolism to reduce the risk of having another blood clot.^{footnote 2} Treatment with anticoagulants may continue throughout your life if the risk of having another pulmonary embolism remains high.

Different types of anticoagulants are used to treat pulmonary embolism. Talk with your doctor to decide which medicine is right for you.

In the hospital, you might be given an anticoagulant as a shot or through an IV. After you go home, you might give yourself shots for a few days. For the long term, you’ll likely take a pill.

Anticoagulants include:

• Apixaban.
• Dabigatran.
• Fondaparinux.
• Heparin.
• Rivaroxaban.
• Warfarin.

Medicine choices

Safety tips for anticoagulants

If you take an anticoagulant, you can take steps to prevent bleeding. This includes preventing injuries and getting regular blood tests if needed.

Thrombolytics

Clot-dissolving (thrombolytic) medicines are not commonly used to treat pulmonary embolism. Although they can quickly dissolve a blood clot, thrombolytics also greatly increase the risk of serious bleeding. They are sometimes used to treat a life-threatening pulmonary embolism.

Surgery

The removal of a clot is called an embolectomy. An embolectomy might be done during a surgery. Or it might be done with a minimally invasive procedure that uses a catheter (a thin tube that is guided through a blood vessel). This type of treatment for pulmonary embolism is used only in rare cases. It is considered for people who can’t have other kinds of treatment or those whose clot is so dangerous that they can’t wait for medicine to work. An embolectomy also may be an option for a person whose condition is stable but who shows signs of significant reduced blood flow in the pulmonary artery.

What to think about

Surgery increases the risk of forming new blood clots that can cause another pulmonary embolism.

Other Treatment

If surgery or medicines are not options, other methods of preventing pulmonary embolism may be considered, such as a vena cava filter.

Other treatment choices

A vena cava filter may be inserted in the large central vein that passes through the abdomen and returns blood from the body to the heart (vena cava). This filter can prevent blood clots in the leg or pelvic veins from travelling to the lungs and heart. These filters may be permanent or removable.

What to think about

Vena cava filters aren’t typically recommended as the first treatment for pulmonary embolism. But they may be used in some people. For example, they may be used if a person cannot take anticoagulant medicine.

Vena cava filters can cause serious health problems if they break or become blocked with one or more blood clots.

References

Citations

1. U.S. Department of Health and Human Services (2008). The Surgeon General’s call to action to prevent deep vein thrombosis and pulmonary embolism. Available online: http://www.surgeongeneral.gov/library/calls/deepvein/index.html.
2. Guyatt GH, et al. (2012). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): 7S–47S.

Credits

Current as of:
March 4, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Anne C. Poinier MD – Internal Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Jeffrey S. Ginsberg MD – Hematology

Deep Vein Thrombosis (DVT) | GW Hospital

Deep vein thrombosis (DVT) is the formation of a blood clot (thrombus) in a vein deep inside the body. The clot may interfere with circulation and break off and travel through the bloodstream where it could lodge in the brain, lungs, heart or other area causing damage. DVT commonly occurs in the lower leg, thigh or pelvis. Occasionally, the veins of the arms are affected.

According to the National Institutes of Health, deep vein thrombosis (DVT) occurs in about one of every 1,000 persons in the U.S. each year. Between one and five percent of those affected by DVT will die from complications. 

Risk Factors

• Age 40 and above
• Immobility, such as bed rest or sitting for long periods of time
• Recent surgery or trauma
• Coagulation abnormalities
• Having a central venous catheter
• Limb trauma and/or orthopedic procedures
• Childbirth within the last six months
• Hormone therapy or use of oral contraceptives
• History of miscarriage
• Obesity
• Tobacco usage
• Previous DVT or family history of DVT
• Previous or current cancer

Symptoms

• Leg pain or tenderness
• Swelling (edema) of the leg or lower limb
• Warm skin
• Surface veins become more visible
• Skin discoloration and/or redness
• Leg fatigue

Pulmonary Embolism

Pulmonary embolism, which can be fatal, occurs when a clot becomes trapped in a lung, blocking the oxygen supply and causing heart failure. The majority of pulmonary embolisms are caused by DVT. With early treatment, those with DVT can reduce their chances of developing a life-threatening pulmonary embolism to less than one percent. Blood thinners like Heparin and Coumadin are effective in preventing further clotting and can prevent a pulmonary embolism from occurring. Some symptoms of a pulmonary embolism include shortness of breath, rapid pulse, sweating, sharp chest pain, coughing up blood and fainting. The symptoms frequently are nonspecific and can mimic many other cardiopulmonary events.

Treatment Options

If a patient has a number of risk factors, ultrasound, magnetic resonance imaging (MRI) or venography/phlebography (x-ray that identifies the veins and blood clots) are used to screen for DVT. 

It is possible for DVT to resolve itself, but there is a risk of recurrence. To help reduce the pain and swelling that can occur with DVT, patients are often told to elevate their leg(s), use a heating pad, take walks and wear compression stockings. In addition, several treatment options are available:

• Thrombectomy Thrombolysis — A catheter-directed thrombolysis is performed under imaging guidance by interventional radiologists. This procedure is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserve valve function to minimize the risk of post-thrombotic syndrome (a common condition in which the clot remains in the leg because the patient was treated with anticoagulants alone). 
• Anticoagulant Medication — Used primarily to prevent fatal pulmonary embolism, patients take a brief course of heparin (an anticoagulant) for less than a week, also start on a 3-to-6 month course of warfarin, which increase in the time it takes for blood to clot. 
• Inferior Vena Cava “Greenfield” Filter — Less commonly used, patients who cannot have anticoagulant treatment or those who have recurrent clots while on medication can have a medical device implanted into the inferior vena cava to prevent blockage of an artery in the lungs by a blood clot (pulmonary emboli). Retrievable filters are becoming more commonly used, especially in young people, but there is an increased risk of inferior vena cava injury if the filter is dislodged or attempted to be removed after three weeks.
• Surgery — Surgical removal of a blood clot considered only in rare cases when the clot is very large, blocking a major blood vessel and causing severe symptoms. Surgery also increases the risk of developing new blood clots.

Prevention 

• Exercise — Exercising your lower leg muscles can improve the circulation in your legs.
• Getting up out of bed — This is especially important after a major illness or surgery. If a person is unable to get out of bed, he/she should do in-bed exercises to keep the circulation going through their legs.
• Compression Stockings — For those who are at increased risk or have abnormal hypercoagulability, compression stockings help prevent DVT.

90,000 from the first signs and prevention to the fight against the disease “- Yandex.Q

With thrombosis of the veins of the lower extremities, thrombi or blood clots form in their cavity, which impede the normal movement of blood. Over time, they can block the venous lumen and even come off. If there is a violation of the movement of blood, where the supply of it is disrupted, then the tissues can die off.

If a blood clot comes off a vessel, it may end up in the heart, lungs, and other organs.Accordingly, it is dangerous because a stroke, thromboembolism or heart attack may occur, and these diseases lead to sudden death or paralysis.

Symptoms and signs of vascular disease

Unfortunately, it is often impossible to timely determine the initial symptoms of thrombosis of the vessels of the legs, but if the skin changes color, and swelling occurs where the blood clot is located, these are signs of vascular disease.Many do not know that this type of thrombosis is almost asymptomatic, and therefore very dangerous.

In a healthy person, venous blood moves from the bottom up: from the legs – to the organs located higher: lungs, heart, etc. If a thrombus blocks the lumen of a vein, then blood will hardly flow from the lower limbs, and they will swell. Since a blood clot can be located in different places, then edema occurs on the lower leg, ankle, and thigh. Sometimes the entire leg swells.

Very few people pay attention to such signs of thrombosis as rare pain, stiffness, a feeling of heaviness and distention in the muscles of the legs and turn to doctors in time.Such a frivolous attitude to one’s own health leads to bad consequences. Sometimes acute thrombosis occurs. A person who moved normally today may not get out of bed tomorrow due to huge swelling. It is extremely serious if, due to the latent form of the course of thrombosis, the patient suddenly has pulmonary embolism (PE). It occurs because a blood clot breaks off and migrates from the affected vessels of the legs into the artery of the lungs, where it is blocked. As a result, the patient develops acute insufficiency of cardiac or pulmonary activity.

To be convincing, a life story known to the author:

A colleague’s mother-in-law, a very healthy woman by nature and never got sick, died within a week from thromboembolism.

And it was like this:

On the way home from the store, a woman stumbled and fell. She was diagnosed with a fracture, put in a plaster cast and sent home for treatment. For 5 days everything went well, her relatives say that the mother-in-law even played the guitar and sang on the day of her death … The sudden death made all people who knew her shudder, and, first of all, children and grandchildren.An autopsy revealed that the cause was a detached blood clot that blocked the pulmonary artery. It’s just that the woman had phlebothrombosis of the legs a long time ago, which did not cause her much inconvenience and therefore remained without treatment.

When thrombosis of the lower extremities progresses, its symptoms are more pronounced. Sharp pain appears and heaviness in the legs increases. These symptoms are provoked by the fact that venous congestion occurs below the site of thrombosis.

As a result of the complete closure of the lumen of the vein, edema increases, metabolism in soft tissues is impaired.This can lead to gangrene.

Swelling and pain in the legs can be not only signs of insufficiency of the vascular system, but also many other diseases. Therefore, it is imperative to visit a doctor.

Ileofemoral thrombosis

This type of vascular disease occupies a separate niche because its course is very severe and there is a high risk of developing pulmonary thromboembolism.Blood clots occur at the level of the iliac and femoral veins.

The signs and causes of this type of disease are the same as in other types of thrombosis.

Ileofemoral thrombosis has a rapid development. The whole leg is swollen. The patient may have an increase in temperature and the appearance of bursting pains.

The color of the thrombosed leg can vary from bluish to pale (with spasm of arterioles). More often, the leg acquires a bluish tint due to the fact that the veins expand and the capillaries fill with blood from the vessels.If the outflow from the veins is at least partially preserved, then the symptoms progress gradually. Otherwise, gangrene may develop. Such a formidable diagnosis helps to confirm the ultrasound of the vessels of the legs.

Treat this type of thrombosis in the same way as others.

What contributes to the occurrence of vascular diseases?

Perhaps, high blood clotting is the main reason. It is also important to damage the vein wall and slow blood flow. These 3 unfavorable factors are called the Virchow Triad.

In addition, the risk of serious problems is exacerbated by:

• Smoking
• Trauma contributes to the development of acute thrombosis. It leads to the fact that the vascular wall is affected and the process of hemostasis is activated. As a result, a thrombus is formed
• Overweight
• Pregnancy contributes to the compression of the iliac veins, and sometimes the inferior vena cava. This leads to an increase in vascular pressure in the veins, which are below 90,080
• During childbirth, a fetus that moves through the birth canal has many opportunities for squeezing the iliac veins
• Very high risk of clogged veins after caesarean section
• Infection causes blockage of blood vessels in men.This is due to the activation of blood clotting factors in response to the vascular walls being affected. Infections provoke chronic forms of the disease (thrombophlebitis)
• Long trips and flights
• Old age
• Taking medications that increase blood clotting
• Operations on joints, abdominal operations. The high prevalence of venous thrombosis is associated with the fact that every year the number of operations using general anesthesia is increasing, as well as an increase in the number of operated elderly people with severe concomitant diseases
• Complicated bone fractures
• The occurrence of vascular thrombosis is promoted by bed rest (for a long time).The reason is the absence of muscle contraction, slowing down of blood flow and venous stasis
• Healthy people also get sick if they sit or stand for a long time (traveling by car, working at a computer)

What examinations are carried out for suspected thrombosis?

To prescribe the correct treatment for thrombosis, you need to know the exact diagnosis. Currently this can be done using methods like this:

1. Duplex scanning allows visualization of the vascular structure, as well as assessment of blood flow
2. If there is any doubt about the results of a scan for vein thrombosis of the lower extremities, as well as if blood clots are located above the groin, doctors prescribe a radiopaque phlebography.In this case, the contrast agent is injected into the patient into the vessel and his condition is monitored
3. MR and CT angiography is also prescribed in doubtful cases
4. If there is a suspicion of pulmonary thromboembolism, then an X-ray of the lungs is prescribed, in particular a scintigraphy with a radioactive marker. The diagnosis of “Deep vein blockage” is confirmed by this procedure and the USDG
5. Impedance plethysmography. The cuff, which compresses the lower leg with force for temporary occlusion of the veins, is loosened, and the change in the volume of their filling with blood is determined.This test, with an accuracy of 90%, allows to detect deep venous thrombosis above the knee level
6. If an infection is suspected, a blood culture is performed

Prevention of blockage of veins

• For the prevention of vascular thrombosis, the legs should not be left motionless for a long time (stand or sit for a long time in one position)
• In the heat, it is advisable to drink more liquid so that there is no blood clotting
• Postoperative and bedridden patients need specific procedures to avoid thrombosis
• If the patient has varicose veins on the legs, it is necessary to promptly carry out surgical intervention
• In case of signs of thrombosis (edema, sharp muscle pain), it is necessary to consult a phlebologist as soon as possible.The time factor plays an important role. The faster the treatment begins, the more successful its results are

Treatment of the disease

Treatment depends on the severity of the disease and the stage of development of thrombosis. First, an accurate diagnosis is required: identifying the location of the blood clot, clarifying its size and the degree of development of thrombosis. It is important to establish how tightly the blood clot is held and whether there is a possibility of its separation.

There are several treatments for leg thrombosis.This is an operation, thrombolysis, treatment with medication and the installation of a cava filter.

Medicinal

• Heparin injections
• Capsules of anticoagulants (Coumadin, Warfarin) when monitoring a blood test
• If there is no improvement, hospitalization is necessary to exclude oncology. After all, there is sad statistics – 50% of patients with cancer die from clogged veins

Thrombolysis

Thrombolysis is a procedure that helps the blood clots to dissolve.It is done by a surgeon. A catheter is inserted into the vessel. A substance that dissolves the blood clot is gradually injected into it. Thrombolysis is not often prescribed because it promotes bleeding. However, there is an undeniable advantage of thrombolysis – it dissolves large blood clots.

Surgery

It is carried out in case of complicated forms of blockage of veins (if there is a possibility of tissue death). The course of surgery depends on the location of the blood clot.In the treatment of deep vein thrombosis, vein applications (suturing), arteriovenous shunt placement and other interventions are performed. In some operations, the goal is to remove the thrombotic mass. Before surgery, the patient needs to be calm so that the blood clot does not separate.

Installation Kava filter

Kava-filter is an umbrella-shaped device made of metal for trapping blood clots that come with the blood stream. It is implanted into the lumen of the inferior vena cava by means of an endovascular technique (through a venous vessel). Therefore, there is no need for open surgery.

Diet for thrombosis

In case of venous thrombosis, a diet is prescribed with a temporary exclusion from the diet of foods that contain a large amount of vitamins K, C and moderate fluid intake.

It is useful to use foods that thin the blood in case of thrombosis. This is pepper, garlic, artichoke.

Alcohol and irritating foods are not recommended.

Important addition:

Studies have shown that if you drive for a long time in order to take part in a sports competition, and then sit in the car again for a long time, phlebothrombosis can begin. Many athletes have suffered from clogged veins after sports.

This happens because after a strong physical exertion, the tension drops sharply, the functions of the body also decrease.The immobile state disrupts the normal blood flow and turns it into a “gel”. Long-term driving after this contributes to the appearance of thrombosis.

To avoid negative consequences, it is recommended to continue driving after the end of the competition, drink a sufficient amount of liquid, interrupt for a warm-up while driving for a long time, immediately after the competition, do not get into the car.

Deep vein thrombosis of the lower extremities is one of the most serious diseases. And your life depends on whether you visit a vascular surgeon or not.

Material provided

doctor.kz

Venous thrombosis – vascular clinic on Patriarch’s

13.11.2013

Venous thrombosis

Venous thrombosis is a partial or complete obstruction of the patency of the lumen of a vein by a thrombus (a clot formed from blood particles). Most often, a person develops thrombosis of deep or superficial veins of the lower extremities. Other parts of the human venous system are affected more rarely, and are mainly complications of other diseases or the result of medical manipulations.

Venous thrombosis can occur both against the background of already existing venous insufficiency, primarily caused by varicose veins of the superficial veins, and in other conditions. The most common reason for the development of venous thrombosis is inflammation of the vein wall (phlebitis), which is a consequence of its infection.

Thrombosis can develop in patients with oncological (tumor) diseases, trauma, pathological processes accompanied by prolonged immobility or immobility (immobilization) of the patient, blood diseases, during pregnancy, childbirth and in the postpartum period, after surgical interventions for various diseases and conditions when taking drugs that increase the activity of the blood coagulation system (contributing to thrombosis), for example, when using hormonal contraceptives.In most cases, acute thrombosis is accompanied by the appearance of symptoms that significantly worsen the general well-being of the patient. The main ones are pain, swelling of the affected limb, redness of the skin, an increase in local temperature or general temperature reactions. In a situation of acute thrombosis, the timing of a patient’s seeking medical help is of fundamental importance. When diagnosing the disease at the initial stages of thrombus formation and timely implementation of therapeutic measures, in most cases it is possible to achieve complete lysis (“dissolution”) of the thrombus, preventing the development of gross violations of venous outflow and clinical manifestations of chronic venous insufficiency.If the patient seeks medical help delayed, the likelihood of a favorable outcome of the disease is sharply reduced. Even with a decrease in the size of the thrombus against the background of the treatment, irreversible changes in the walls of the veins and the valve apparatus develop, which prevents the normalization of venous hemodynamics and is accompanied by a progressive increase in the clinical picture of chronic venous insufficiency. This condition is called post-thrombotic disease (or post-thrombophlebitic syndrome).The most difficult is the clinical prognosis in the development of deep vein thrombosis, especially widespread. This is due to the fact that normally the main volume of blood from the leg flows through the deep vein system. If their patency is impaired, gross disorders of venous outflow occur, accompanied by a malnutrition of tissues with the appearance of puffiness, discoloration of the skin, and the formation of ulcers.

Venous thrombosis is the main cause of pulmonary embolism and infarction pneumonia (inflammation of the lungs associated with impaired blood supply).This condition leads to severe clinical consequences and even death. The development of thromboembolism is based on fragmentation of a thrombus in the veins of the lower extremities. Physical activity, weight lifting, floating (mobile) or pseudoflotting (semi-mobile) nature of the thrombus, localization of the apex of the thrombus in large-caliber veins (iliac, femoral) contribute to the development of thromboembolism.

Thus, regardless of the cause of the development of venous insufficiency, its final outcome is the same.And the way in which it can be avoided is also the same – seek medical help as early as possible and carry out adequate medical measures. At the same time, it should be understood that, all other things being equal, the long-term prognosis is always worse in situations of venous thrombosis, no matter how early it is diagnosed. Therefore, in the presence of risk factors for its development, one of which is varicose veins, it is necessary to take preventive measures to avoid the development of thrombosis.

If you have signs characteristic of venous thrombosis (swelling, heaviness, pain in the legs or other symptoms) or its consequences, do not wait for the development of formidable complications, please contact us.We will conduct an examination and, if necessary, prescribe treatment. We have every opportunity both for early detection of vascular processes and for verification of their advanced stages. Our pharmacy has all the drugs necessary for the prevention and treatment of cardiovascular diseases at competitive prices.

Thrombophlebitis: symptoms and treatment | Deep vein thrombophlebitis of the lower extremities (legs)

The vessels of the venous system are often subjected to various inflammatory processes, the direct consequence of which is thrombophlebitis.With inflammation, a blood clot forms on the vein wall – a thrombus, which partially or completely blocks the blood flow in the vessel. Both superficial and deep veins can suffer from this pathology, and the signs of thrombophlebitis in both cases can differ in intensity. Acute and chronic forms of the disease are known, the subacute form is also classified. In some cases, a purulent formation and even gangrene develops. The disease affects the lower extremities much more often, although thrombophlebitis of the upper extremities is also not uncommon.

Thrombophlebitis: symptoms and signs

External signs of thrombophlebitis depend on the form of the disease. In addition, it is often associated with other pathologies. Often it is preceded by varicose veins, so patients with this pathology need to consult a qualified doctor as soon as possible, who will develop an effective program to prevent blood clots.

In any case, the appearance of thrombophlebitis does not go unnoticed, since the walls of the vein undergo significant changes, blood pressure increases due to impaired blood flow, and the inflammatory process causes an increase in body temperature.There is pain in the area of ​​the affected vessel (especially sharp in the acute form). Regional lymph nodes may enlarge.

A thrombus that is torn off under the pressure of the bloodstream clogs the smaller vessels. This can also happen in the brain, lungs, heart. The patient has symptoms of myocardial infarction, stroke, mesenteric thrombosis of intestinal vessels, pulmonary embolism. Most often, a sign of a detached blood clot is:

• sharp pain;
• coldness of the extremities;
• blue skin;
• lack of air.

An urgent need to see a doctor, since a blocked vessel can cause death .

Thrombophlebitis of the superficial veins of the lower extremities

It is this form of thrombophlebitis of the legs that is considered the most common, and it is most often preceded by varicose veins. A thrombus is evidenced by a seal on the vessel, as a result of varicose veins that have taken on a convex shape and are clearly visible under the skin. As the thrombus expands and lengthens, the vein becomes like a stretched subcutaneous cord.

The tissue around the blood clot swells and the skin turns red. The process is accompanied by acute pain, which increases when pressing on the area of ​​thrombus formation. Usually, thrombophlebitis of the veins of the lower extremities does not prevent the patient from moving his leg, but the movement can be very painful. Body temperature does not exceed 37.5 degrees. Sometimes inflammation can spread to neighboring tissues – periphlebitis occurs.

The acute form of is mainly due to infection.A thrombus forms in the focus of infection, provoking, in turn, inflammation of the vessel wall. Acute superficial thrombophlebitis of the lower extremities causes an increase in temperature to 38 ^about , and then it returns to normal. Seals are felt under the skin, the size of which depends on the diameter of the vein in which the thrombus has formed.

Chronic form is characterized by prolonged congestion in the lower limb, increased swelling and pain after exertion on the legs.In addition, pus can form in the affected tissues, and abscesses can form on the skin.

Thrombophlebitis of the superficial veins of the upper extremities

This disease in an acute form is rarely diagnosed. This is mainly a consequence of errors in intravenous injections, catheterization, drug infusion, and various injuries. When diagnosed, a violation of the vein wall is detected. The blood flow slows down, and its clotting increases. In general, superficial thrombophlebitis of the hands has similar symptoms to the disease of the lower extremities.

Deep vein thrombophlebitis

The signs of this type of pathology largely depend on the location of the affected vessel. Among the acute forms, thrombophlebitis of the deep veins of the leg is distinguished by its frequency. It is characterized by the appearance of sudden pain, bursting the muscles of the lower leg. The pain may subside slightly if the leg is placed in a horizontal position. However, an almost painless manifestation is also possible in the presence of other symptoms of thrombophlebitis: edema, bluish color of the skin and its tension.When pressed on the skin, a fossa remains, which is gradually smoothed out.

On the other hand, the disease can pass without any obvious signs at all. With thrombophlebitis of the femoral vein and deep veins of the pelvis, the presence of a thrombus may be indicated by small swelling on the inner thigh and mild pain in the groin area. Thrombophlebitis of the ilio-femoral segment of the main vein also has implicit signs. It manifests itself as mild pain in the lower back, near the sacrum, in the lower abdomen.And in some cases, the only symptom may be thromboembolism – when the blood clot has already come off.

Deep vein thrombophlebitis of the lower extremities also manifests itself in the form of general malaise. Body temperature can rise to 40 ^about . And if the common femoral vein is damaged, the patient may have a fever, there are signs of intoxication of the body.

The acute form of in almost all cases is characterized by the appearance of acute pain at the site of blood flow disturbance.The swelling may be loose at first and then gradually harden. In the area of ​​the lesion, veins clearly appear on the surface of the skin, the temperature rises significantly. When making a diagnosis, the doctor places a sphygmomanometer cuff next to the affected area and monitors the increase in pressure at which acute pain occurs. In acute cases, a pressure of 45-60 mm Hg is sufficient.

For the chronic form of is characterized by a long course, and the symptoms of thrombophlebitis can appear from time to time for 2-3 years without significant deterioration.The thrombus can be partially destroyed, the permeability of the vessel is temporarily improved, and the vein wall is overgrown with connective tissue. But since the outflow of blood from the lower extremities is impaired, the symptoms return:

• swelling becomes persistent;
• Feeling of fullness and heaviness in the leg pursues when walking;
• severe muscle cramps occur at night;
• dense formations appear under the skin;
• the skin itself acquires a ring-shaped pigmentation.

Since with such symptoms of thrombophlebitis of the lower extremities, the likelihood of dermatitis, eczema, trophic ulcers is extremely high, it is necessary to start treatment as soon as possible.

How is thrombophlebitis treated?

Depending on the form and severity, thrombophlebitis is treated at home or on an outpatient basis. At home, you can treat lesions superficial vessels hand, forearm, foot, lower leg.At the same time, the patient’s physical activity is limited, special ointments are applied locally to improve blood circulation, cold, elastic bandages. Inside – anti-inflammatory drugs, antibiotics. Physiotherapeutic procedures are prescribed – magnetotherapy, impulse currents, etc. Particular attention is paid to prevention.

Treatment for symptoms of thrombophlebitis of the lower extremities, characterized by lesions of deep veins , is carried out exclusively in a hospital, since there is a threat of embolism.Surgery may be needed to remove a large blood clot, suppuration, gangrene, etc.

Compression treatment

This method is used most often in the chronic course of the disease, after the inflammation subsides and for prophylaxis. In addition, it is only effective for superficial venous thrombophlebitis . With deep vein pathology, it is not prescribed.

Medical jersey is used: tights, stockings, knee-highs of different lengths and with compression class 2 or 3.The use of special elastic bandages is effective. Bandaging is carried out at the beginning of the day, and at night the bandages are removed. This helps to keep the tissues of the limb toned. Knitwear and bandages prevent varicose veins and thrombus separation. After a few days, it can completely dissolve.

Also, in the chronic and subacute form, warming compresses are prescribed. They improve blood circulation and elasticity of tissues and blood vessels.

Physiotherapy

Physiotherapy treatment of thrombophlebitis of the lower extremities is effective in the chronic form of superficial thrombophlebitis and includes a number of measures:

• infrared rays;
• sollux;
• magnetotherapy;
• electrophoresis;
• ultraviolet irradiation;
• impulse currents.

These methods are not used in the presence of trophic formations and during periods of exacerbation. A trip to the balneonological resort is possible only after consulting a doctor and requires a special appointment.

Separately, it is worth noting hirudin therapy – treatment with leeches. This method is applicable in acute form and if the patient experiences an intolerance to anticoagulant drugs (reducing blood viscosity). In this case, the role of these drugs is played by hirudin, which is contained in the glands of leeches and enters the patient’s bloodstream.However, their use is strictly individual, has serious contraindications and requires mandatory agreement with the attending physician.

Drug treatment

Prescription of medications for thrombophlebitis should be complex:

• Anticoagulants reduce blood clotting;
• non-steroidal anti-inflammatory drugs and antibiotics act on the very cause of blood clots – infection;
• pain relievers are used for severe pain;
• special external ointments help dissolve blood clots, anti-inflammatory gels are also applicable;
• enzyme therapy is carried out to dissolve a blood clot and eliminate edema;
• the action of venotonics is aimed at strengthening the walls of blood vessels and increasing their elasticity;
• can also be additionally prescribed angioprotectors.

For the treatment of thrombophlebitis, the use of rutin is important. It increases the tone of large vessels, strengthens their walls, reduces swelling and inflammation. No less important is the heparin contained in ointments. Their use avoids internal medication.

In the absence of severe complications, the effect of drug therapy is felt within a few days.

Surgical intervention

The main indication for surgery is progressive thrombosis, when there is a high likelihood of embolism and other complications.

Modern medicine offers a wide range of the latest minimally invasive procedures that allow you to get rid of complex blood clots without extensive surgery.

• The cava filter implanted in the inferior vena cava is an effective tool for trapping blood clots and reducing the risk of complications.

• Radiofrequency obliteration of the vessel consists in sealing the vein and excluding the thrombus from the circulatory system.

• High temperature laser coagulation of also isolates the affected vein and creates a new pathway for blood flow.

• The use of sclerosants , which “glue” the vein, minimizes interference with the body.

• Venous thromboectomy is the removal of a blood clot through a tiny incision with endoscopic instruments and a catheter.

It should be noted that most of these procedures take no more than 3 hours, after which the patient spends about a day in an outpatient clinic under the supervision of doctors, and the next day he goes home.

Why is it important to be treated in a modern clinic?

Thrombophlebitis lends itself well to treatment without surgery, if the patient did not delay going to the doctor and did not self-medicate at home. That is why it is important to see a doctor at the first symptoms.The causes of the disease – inflammation of the vessel wall and blood clotting disorders – can be eliminated only through professional medical care provided by experienced doctors in a modern clinic. Not to mention the acute forms of the disease, the treatment of which is carried out only on an outpatient basis, since there is a risk of life threatening.

Treatment of thrombophlebitis in the CBCP clinic

The CBCP Center for Circulatory Pathology is your opportunity to completely protect yourself from the unpleasant consequences associated with thrombophlebitis.You will be welcomed by highly qualified experienced doctors trained in European clinics. At your service – the latest diagnostic equipment from leading world manufacturers. You will receive qualified treatment according to effective methods used in the best clinics in Europe, the USA and Israel.

GKB №31 – Phlebology | City Clinical Hospital No. 31 of the city of Moscow

When is it necessary to see a phlebologist?

The help of a phlebologist may be required if the patient has the following symptoms:

• expansion of the saphenous veins;
• redness of the skin in the projection of the veins;
• thickening of the veins;
• swelling and pain in the limbs;
• pulsation in the area of ​​blood vessels;
• heaviness or hot sensation in the legs;
• the occurrence of cramps in the limbs;
• spider veins and capillary nets on the legs;
• numbness, induration, redness on the limbs;
• the occurrence of trophic ulcers on the legs.

Especially often elderly people, pregnant women, patients genetically predisposed to such diseases, as well as people leading a sedentary lifestyle are susceptible to venous pathologies. If you notice at least one of the listed symptoms, be sure to sign up for a consultation with a phlebologist!

Types of venous diseases

Modern phlebology allows effective treatment even in advanced cases of varicose veins.In addition, the currently used treatment methods also help to cope with other pathologies of veins and arteries. Among them:

It occurs as a result of injuries, cancer and other serious diseases, due to surgery, blood clotting disorders and even a long plane flight. The main symptoms of thrombosis are pain and severe swelling in the lower extremities. This condition is dangerous to human life, so it is imperative to consult a doctor.Therapy of the disease depends on its severity and degree of prevalence: sometimes conservative methods are enough, and in other cases it is impossible to do without surgery.

• Thrombophlebitis.

Occurs as a result of varicose veins. It manifests itself in the form of a painful strand on the superficial vein, swelling and redness on the legs. A blood clot can grow, invading more and more veins, and spread to deep veins, causing thrombosis.If symptoms of thrombophlebitis occur, it is important to visit a doctor in a timely manner. This pathology is mainly treated with conservative methods. But emergency hospitalization and subsequent surgery may be needed if thrombophlebitis flows into the ascending stage. During surgery, the affected vein is ligated. New techniques using a laser in many cases can allow these operations to be carried out without incisions and hospitalizations.

• CVI (chronic venous insufficiency).

It manifests itself in the form of pain, swelling and heaviness in the legs in the late afternoon. Gradually, these conditions begin to appear in the morning and afternoon. Also CVI can occur in the form of itching, pigmentation, the presence of trophic ulcers on the skin of the legs. The disease is a complication of varicose veins and post-thrombophlebitic syndrome.

• Post-thrombophlebitis syndrome.

Develops after a cured thrombophlebitis or thrombosis.The main treatment is to compensate for the pressure arising in the veins with the help of compression hosiery, as well as the use of venotonics that strengthen the walls of the vessels. This condition cannot be treated surgically.

The root cause of all these pathologies is varicose veins.

Let’s talk about it in more detail.

What is varicose veins?

Varicose veins are a disease in the course of which there is an irreversible lengthening and expansion of the veins.This happens due to the destruction of the venous valves: due to the effect of gravity, blood begins to rush downward when a person is in an upright position. That is, it, in fact, moves in the opposite direction, which causes pathological reflux and an increase in pressure in the vein.

The venous wall cannot withstand the pressure, it stretches and becomes thinner. In those places where the wall becomes weaker, varixes appear – protrusions in the form of a ball. Unfortunately, the reasons due to which the venous valves are destroyed have not yet been identified.

There are a number of factors that contribute to the development of varicose veins.

This is:

• a sedentary lifestyle or, conversely, excessive physical activity;

90,079 childbirth and pregnancy;

90,079 excess weight;

• genetic predisposition.

Varicose veins are not a cosmetic defect, but a serious disease that results in the pathologies listed in the previous section. All of them are rather poorly amenable to therapy, so it is imperative to consult a doctor when the first signs of varicose veins appear!

Contact a phlebologist, and after a thorough examination, he will prescribe a competent therapy that will help to cope with the disease!

Features of the diagnosis of venous pathologies

At the first consultation with a doctor, the patient is examined and a diagnosis of pathology is prescribed.The doctor’s examination first takes place orally. The patient describes his symptoms, on the basis of which the phlebologist makes a preliminary diagnosis. Further, he examines the upper and lower limbs of a person for the presence of swelling, seals, discoloration of the skin, the degree of its elasticity.

At the second stage, the doctor prescribes complex examinations of the veins.

Ultrasound examination is of particular importance in this case. Let’s dwell on it in more detail.

This type of diagnostics is by far the most informative method to establish the state of blood vessels. That is, ultrasound completely complements the picture of the disease, helps to establish the degree of violations and subsequently prescribe competent treatment.

Doppler of veins is one of the types of ultrasound examination.

It evaluates the speed, direction, and nature of blood flow in real time. There are several types of Doppler ultrasonography:

1. Color mapping that allows you to visualize blood flow in veins and arteries, highlighting it in different colors.With the help of such a study, a complete characterization of blood flow and vascular morphology is given.
2. Power Doppler. Displays vessels of different diameters, including the smallest. With the help of this study, the level of blood supply to certain pathological zones and organs is assessed.

To obtain the most informative results, duplex vein scanning can be used, during which Doppler ultrasound and traditional ultrasound examination are combined.There are no contraindications for the use of these techniques. They are absolutely safe and can be used even during pregnancy. To prepare for an ultrasound scan, no special preparation is required, which is also an undoubted advantage of the method. Ultrasound examination is an informative, convenient and minimally invasive method for diagnosing a patient, which allows a phlebologist to obtain the most accurate data on the state of the patient’s vessels.

So, the list of examinations of a patient with venous diseases includes:

• Ultrasound of the lower extremities, which helps to determine the state of blood vessels and vascular walls;
• dopplerography – an ultrasound study that helps to study the problem in as much detail as possible and to identify whether the patient has blood clots;
• hemostasiogram – blood tests to determine its coagulability;
• tests for the presence of thrombophlebitis, with the help of which blood clots and a predisposition to their occurrence are detected;
• CT, which examines the state of blood vessels;
• ECG, etc.

After receiving the diagnostic results, the doctor prescribes adequate treatment for the patient, choosing the most appropriate methods – either surgical or conservative.

How venous pathologies are treated

Therapy for venous diseases is always prescribed individually. The technique is chosen depending on the type and severity of the disease.

In mild cases, for example, at the initial stage of varicose veins, cosmetic phlebology helps.Spider veins are removed with microsclerotherapy . The doctor inserts a special sclerosing substance into the vessel using a very thin needle or removes stars with a laser.

At the second stage, namely, with the destruction of the valves of the superficial veins, other types of therapy may be prescribed, including:

• surgery under general anesthesia ;
• RF obliteration;
• laser phlebology , implying the use of two methods: coagulation and miniflebectomy.

In the advanced stage, when the patient develops trophic ulcers, different methods of therapy are used.

The primary task of the doctor is to prescribe drugs that accelerate the healing of ulcers and relieve inflammation from the veins. Then surgery is applied: during it, the same methods are used as in the second stage of varicose veins.

City Clinical Hospital # 31: many patients choose us!

If you have any problems with veins, contact the specialists of our medical institution.We are chosen by a huge number of patients, and here’s why:

1. The hospital employs exclusively professionals in their field, with extensive experience and a wide range of knowledge.
2. In the course of diagnostics and therapy, modern expert-class equipment is used.
3. The cost of services at City Clinical Hospital No. 31 varies within optimal limits and is available to most average patients. We offer the lowest prices in the city for the services of our specialists.
4. After surgery, patients can be seen by our doctors absolutely free of charge for 1 year.
5. If necessary, you can get advice from any related specialists: doctors of various profiles work in City Clinical Hospital No. 31.

You can see the prices for the whole range of services in the table below.

You can make an appointment with a specialist or ask questions that interest you using the feedback form or contacts indicated on the site.

90,000 Deep vein thrombophlebitis of the lower extremities: treatment, symptoms – “Dobrobut”

Venous thromboembolic complications (VTO) – this term combines three acute vascular pathologies, which are characterized by the formation of blood clots.These conditions include acute thrombophlebitis or varicothrombophlebitis (TF or VTP), deep vein thrombosis or acute venous thrombosis (AVT), and pulmonary embolism (PE) . These diseases affect the venous system, are very dangerous, often life-threatening, are distinguished by a very wide variety of manifestations and a severe, malignant course. The social and economic significance of these diseases is due to fatal complications, the development of a rather severe chronic post-thrombotic disease after a thrombosis, frequent disability of patients, as well as high mortality, incl.h. sick leave.

The history of deep vein thrombosis is more than 400 years old, and the first mention of phlebothrombosis appeared in the medical literature 300 years ago. Special interest in deep vein thrombosis arose after the creation of the theory of venous thromboembolism, when a triad of causes leading to the formation of blood clots in blood vessels was formulated: increased blood clotting, damage to the inner surface of the vessel, and slowing down of blood flow velocity. These components remain absolutely relevant today.Further studies were devoted to a deep study of the body’s response to thrombosis and factors affecting the spread of thrombotic masses, as well as changes in response to the thrombotic process in the body as a whole, in the coagulation system in particular, and in the affected vessels. It should be noted that in recent years there have been global changes in diagnostics (modern ultrasound machines and spiral CT have appeared), completely new, more effective, safe and convenient drugs for the treatment and prevention of thrombosis have been developed and introduced into practice, completely new , clear and specific standards for the treatment of these serious diseases, as well as radically changed approaches to tactics and methods of treatment.

The main risk factor for VTO is varicose veins of the lower extremities (VLD). With this disease, a significant amount of “excess” blood accumulates in the dilated veins of the legs, the blood flow rate sharply slows down, which leads to the formation of blood clots in the superficial veins. As you know, with pronounced varicose veins, “abnormal” connections develop between superficial and deep veins, so blood clots from superficial veins easily enter the muscle or connecting (perforating, communicating) veins, and then into deep veins.Deep vein thrombosis is already more dangerous and severe, and with the spread of blood clots up the bloodstream to the heart, it leads to the most severe and fatally dangerous complication – pulmonary embolism.

Thrombophlebitis

Thrombophlebitis – a disease in which blood clots form in the superficial veins. It happens on its own rarely, it occurs against the background of injuries, with hypothermia and overheating, as a result of certain diseases, incl. blood (thrombophilia), previous infections (erysipelas), hormonal changes, severe bleeding disorders (taking certain medications).However, still most often blood clots form in the altered superficial veins – varicose veins. In this case, the disease is called varicothrombophlebitis.

The main signs of thrombophlebitis is the sudden appearance along the normal or varicose veins of a dense cord, which is sharply painful when touched and hot, the skin over it is sharply red. Thrombophlebitis is always accompanied by a pronounced inflammatory reaction of the tissues surrounding the veins.One of the common symptoms is leg swelling, sometimes the body temperature may rise. Such seals form on the lower leg, but can gradually spread to other parts of the lower leg and thigh. In this case, they speak of ascending thrombophlebitis and this indicates the malignancy of the process, the growth of a thrombus and a high risk of its migration due to the transition to deep veins and blood vessels of the heart. This condition is an indication for an emergency operation. Thrombophlebitis is also local, when blood clots have formed in one small area and do not bother you.In such cases, conservative treatment is possible, the use of elastic compression and certain medications, as well as active local therapy. However, it is necessary to be aware that any thrombotic process in the body is always active, unpredictable and dangerous for the development of further complications – the formation of blood clots in other vessels, for example, the heart or brain.

Even with the onset of improvement, a decrease in inflammation, after a while the process can resume again.Based on this, any thrombophlebitis is an indication for surgical treatment of – removal of the affected veins with blood clots. Such an operation is technically difficult, quite traumatic, with a long rehabilitation period and no cosmetic effect. It is for this reason that experts always insist that varicose veins be removed on time, in the initial stages, without complications, because at this stage of the development of the disease, modern technologies of outpatient surgical treatment can be used, which can no longer be used for complicated varicose veins.

Diagnosis of thrombophlebitis is carried out during examination and does not cause difficulties, an ultrasound of the veins is additionally performed in order to clarify the localization of thrombotic masses and the absence of their spread to deep veins, as well as the choice of a surgical method.

Phlebothrombosis

When blood clots occur in deep veins, acute phlebothrombosis develops , a dangerous and serious disease of the veins of the lower extremities, requiring immediate and massive treatment.It is this disease that is most dangerous by the separation of a blood clot and getting it from deep veins into the vessels of the heart and a possible death. Thus, venous thrombosis is rightfully considered a potentially life-threatening condition.

Phlebothrombosis can occur both spontaneously (during a long flight and travel) and in the elderly, and against the background of many diseases (heart, blood, cancer, connective tissue diseases, congenital diseases of the coagulation system).Deep vein thrombosis is very often caused by leg injuries and prolonged immobilization after them, sudden overheating, severe water imbalance due to an improper diet, taking certain medications, hormonal imbalances, and overweight. Very often, thrombosis complicates the surgery, as well as the course of pregnancy and childbirth.

The main manifestations of phlebothrombosis are sharp pains in the lower leg, arising suddenly, a person feels like a tension in the strings in the muscles, a pronounced feeling of compression and bursting in the lower leg, which intensify when walking and moving the foot.Also, the most obvious sign of thrombosis is always pronounced swelling of the leg or thigh, depending on the localization, as well as very dense and tense, depending on the massiveness of the vein lesion. Also, a change in the color of the skin of the legs, its blue discoloration can be attributed to a frequent sign of thrombosis. Therefore, if such symptoms occur, you must immediately contact a specialist for timely and adequate treatment.

Subsequently, with a favorable course of deep vein thrombosis, without its progression and development of PE, a condition is formed, which is called postthrombotic disease .This pathology develops gradually, in direct connection with the process of resorption of blood clots in the veins, since the thrombotic process affects the vein wall and venous valves, which no longer work normally. This disease is manifested by signs of chronic venous insufficiency, persistent pain and edema syndrome, the appearance of varicose veins, and subsequently very often – trophic changes in the skin of the legs and, as a result, trophic ulcers.

It should be noted that very often the clinical picture of phlebothrombosis is “blurred”, implicit, disguised as signs of another disease (with injuries), and sometimes they are generally asymptomatic (“mute” phlebothrombosis).As a result, as if suddenly there are severe complications, as if “out of the blue.” This is most often observed during the period of immobilization after the trauma.

Diagnosis of venous thrombosis is carried out by ultrasound examination. Modern ultrasound devices make it possible to accurately diagnose deep vein thrombosis, visualize the localization of thrombotic masses, their nature (occlusive, parietal, floating), the boundaries of the thrombotic process, assess the massiveness of the lesion, the degree of impaired venous circulation and the state of the pathways for compensating blood flow.In addition, laboratory tests of the blood and coagulation system are needed in order to further monitor changes during treatment and determine its effectiveness. In some cases, contrast computed tomography (phlebography) can also be performed. In addition to instrumental methods, laboratory diagnostics of blood, coagulation system, as well as determination of a marker of thrombosis – D-dimer, are necessary.

Treatment of phlebothrombosis directly depends on the timing of thrombosis.The sooner the treatment of this dangerous condition is started, the more positive its effect will be and the less pronounced the consequences of the disease will be. There is a concept of “golden” 6-12 hours – this is the first hours after the onset of thrombosis, when it is possible to actively influence the “growing” thrombus by introducing special drugs – thrombolytics, which dissolve the thrombus. Such drugs can be administered either systemically, in the form of intravenous infusions, or locally, i.e. directly into a thrombosed vessel (so-called catheter thrombolysis).If this time is missed, then active and massive conservative therapy is prescribed, aimed at various components of the thrombotic process.

The main treatment for any thrombosis is anticoagulants – a group of drugs that “thin” the blood and prevent it from “clotting”. These drugs are administered in stages: first, more active direct anticoagulants are introduced by injections, and then the patient is transferred to the administration of indirect anticoagulants in tablets, which must be taken for a sufficiently long time.This treatment is aimed at stopping the formation and spread of blood clots, as well as helping the body to gradually “dissolve” blood clots. It should be noted that the gradual resorption of thrombotic masses in the veins occurs, if independently, for a long time, most often several years. This process leads to the development of post-thrombotic disease, in which both the vein wall and the valve apparatus are affected, and these changes are often irreversible. If the treatment is started on time, professionally and with modern drugs, the resorption of blood clots occurs, firstly, in a controlled and predictable manner, and secondly, much faster.When using anticoagulants of the latest generation, this process lasts from 3 to 6 months, proceeds more benignly, while CVI phenomena are less pronounced and have a compensated course. The clear advantages of the new anticoagulants include greater safety, the absence of the need for constant monitoring of blood coagulation parameters, as well as the convenience of taking these drugs. In addition, compulsory components of the treatment of phlebothrombosis of any localization are mandatory compliance with the regimen of elastic compression of the legs (elastic bandages or medical compression hosiery) and taking phlebotropic drugs.

It should be noted that in certain situations, when the clinical picture of phlebothrombosis is pronounced with the presence of pronounced and intense edema of the limb and a sharp pain syndrome, and an ultrasound examination revealed localization of thrombotic masses at the top of the thigh with spread to the veins of the small pelvis, when there is a high probability of separation a piece of a thrombus and its migration into the vessels of the heart, as well as in a situation where thrombosis affects several segments (thrombi in the veins throughout the leg), when the effectiveness of conservative therapy is in doubt and the achievement of a positive result seems doubtful, indications for surgical treatment are presented.

This operation removes blood clots and restores venous blood flow. Sometimes, if it is impossible to perform the operation and if there is a high risk of fatal complications, implantation of a special “thrombus catcher” – a cava filter, is performed in the main vein of the abdominal cavity. However, all world standards have recently given preference to temporary kava filters, i.e. which are removed after reducing the risk of the spread of blood clots, since the permanent filters that were installed until recently caused a large number of complications, aggravated the course of the disease and the process of resorption of blood clots due to a pronounced violation of venous circulation.After surgery, a course of massive conservative therapy is required in stationary conditions. It should be noted that recently a large number of studies have been carried out and the development of low-traumatic methods of removing blood clots with the possibility of performing them on an outpatient basis.

It should be noted that against the background of timely and adequate treatment of phlebothrombosis, only 5% of cases develop PE, leading to death in only 1% of patients.

Patients who have undergone phlebothrombosis should be under the supervision of a narrow specialist in order to control the course of the disease, the severity of the clinical manifestations of post-thrombotic disease, the effectiveness of the therapy, as well as targeted control of the process of resorption of blood clots using ultrasound. Such monitoring makes it possible to respond in a timely manner to any changes, adjust prescriptions and guarantee the maximum possible positive treatment result.

Pulmonary embolism (PE)

In case of malignant thrombotic process, its progression or lack of timely treatment, blood clots spread from the bottom of the veins of the legs to the veins of the heart. In this case, a condition known as pulmonary embolism (PE) occurs. In this case, blood clots enter the vessels of the pulmonary circulation, the vessels of the lungs and cause a sharp overload of the respiratory and cardiac systems. Such violations are very often fatal.This disease is one of the causes of death of a large number of people, along with heart attacks and strokes, which are also thrombotic processes. Mortality in this disease reaches 30%. Massive PE as a cause of sudden death ranks second after circulatory arrest due to heart disease and third among the causes of death in the population.

PE is characterized by sudden onset, lightning-fast development and severe severity of cardiopulmonary disorders.In this condition, loss of consciousness, hemoptysis, a sharp blue face, severe shortness of breath, cough, interruptions in cardiac activity, rhythm disturbances, severe chest pains, aggravated by breathing, a sharp drop in blood pressure, often develops a heart attack of the affected lung. However, unfortunately, classical manifestations are noted very rarely, often disguised as other diseases.

Risk factors for PE include:

• old age,
• injuries, especially with prolonged immobilization,
• obesity,
• some surgical operations,
• pregnancy,
• early postpartum,
• taking hormonal drugs (contraception, substitution therapy),
• oncological diseases,
• chronic heart failure,
• systemic connective tissue diseases,
• rheumatism,
• atrial fibrillation,
• previously transferred thrombosis,
• severe infections,
• bed rest,
• Peripheral venous catheterization for infusion therapy,
• varicose veins,
• congenital diseases of the blood coagulation system.

PE is a problem faced by both surgical and therapeutic professionals. The problem of diagnostics is the limited time for its implementation and the need for a quick start of treatment. The diagnosis of this disease is based on the suspicion of a disease in the presence of characteristic symptoms and risk factors. The most informative diagnostic methods are angiopulmonography – contrast study of the vessels of the lungs and heart under X-ray, as well as spiral computed tomography and contrast MRI.The disadvantage of the first method is its invasiveness; in terms of the quality of the information obtained, all these methods are almost identical. Therefore, in recent years, preference has been given to non-traumatic diagnostic methods – CT and MRI. Additional diagnostic methods include ECG, ultrasound of the heart, X-ray of the lungs, scintigraphy of the lungs, ultrasound of the veins of the lower extremities; in laboratory diagnostics, the level of D-dimer, specific cardiac troponins, indicators of the coagulation system are examined.

Treatment of PE is a serious clinical problem, on the one hand, because of the time frame for effective measures, on the other hand, because of the pronounced disorders of the vital functions of the body and the need for their fastest correction.

If the patient is delivered to the hospital on time, then after assessing the degree of PE, performing the necessary diagnostic tests and conducting primary stabilization measures, specific therapy will be started. In the first hours after the onset of pulmonary embolism, thrombolysis is the most effective and favorable in prognostic terms, i.e. dissolution of a blood clot with certain substances. As a rule, systemic thrombolysis is performed (by intravenous infusion), but sometimes regional thrombolysis is also used, i.e.That is, when the drug is injected directly into a vessel that is filled with thrombotic masses. This method will be most effective in the first 6-12 hours after the onset of the disease, less – during the next 24-48 hours, then its effectiveness will significantly decrease and, moreover, cause a high risk of complications – bleeding, although a positive effect can be expected after 2 weeks from onset of the disease. In parallel and in the future, massive anticoagulant therapy will be carried out, carried out in stages using various groups of anticoagulants, which is often used as an alternative to thrombolysis.The main difference between these two methods of treatment lies in the speed of the onset of the effect and the frequency of achieving the result – more aggressive thrombolytics are characterized by a quick onset of action and a more complete restoration of the patency of the vascular bed due to active splitting of the thrombus. However, the risk of developing massive bleeding, as a complication of treatment with thrombolytics, is several times higher. Therefore, thrombolytics are currently used in patients with a high PE-associated risk of death in cases where the rate of recovery of pulmonary blood flow is critical for patient survival.

In specialized hospitals, surgical treatment is also possible – removal of blood clots (the operation belongs to the category of cardiac surgery), mechanochemical thrombolysis or thrombectomy, implantation of a cava filter. However, surgical methods are rarely used, since the possibilities are limited by the patient’s condition and the high risk of complications and mortality.

Intensive therapy measures are of great importance in the treatment of thromboembolism, as well as symptomatic therapy, correction of respiratory failure, restoration of hemodynamics, adequate and rapid recovery of the body’s vital functions.It is necessary to note the need for a high level of personnel training to provide timely and appropriate assistance.

Treatment of this formidable disease is based on a differentiated approach to the choice of treatment tactics and combined antithrombotic therapy. At the moment, international standards and recommendations for the treatment of PE, based on the principles of evidence-based medicine, have been developed and introduced into clinical practice.

These principles are also guided by us in our practice.As a multidisciplinary clinic, MC “Dobrobut” has all the modern capabilities for the successful and timely treatment of any venous thromboembolic complications, including the possibility of providing emergency and urgent care.

The article was prepared by a vascular surgeon of the highest category, phlebologist Gerasimov Vladimir Vladimirovich.

To receive information about treatment and make an appointment, call the Dobrobut MC contact center:

044 495 2 888 or 097 495 2 888

Phlebologist’s consultation
Varicose veins during pregnancy

Thrombophlebitis: treatment

If thrombophlebitis affects a superficial vein, your doctor may recommend home treatment for thrombophlebitis.

This usually involves applying a cold compress to the painful area, keeping the affected leg elevated, and using non-steroidal anti-inflammatory drugs.

This condition usually does not require hospitalization, recovery occurs within 1-2 weeks.

The doctor may also prescribe the following procedures and drugs for the treatment of thrombophlebitis and deep vein thrombosis:

• Compression stockings. They prevent the recurrence of edema and reduce the risk of complications in superficial thrombophlebitis and deep vein thrombophlebitis.The doctor will select for you compression stockings with the required degree of compression.
• Blood thinning drugs (anticoagulants). In the treatment of deep vein thrombophlebitis, an anticoagulant, such as heparin, is injected to stop the growth of the clot.
  After treatment with heparin, oral anticoagulants are usually prescribed for several months. They also prevent further clot growth.
  If oral anticoagulants are prescribed, follow directions and use caution during administration.Anticoagulants are powerful drugs that can cause serious side effects, such as heavy bleeding.
• Preparations that dissolve blood clots (fibrinolytics). This type of treatment for thrombophlebitis is known as thrombolysis. Fibrinolytics dissolve blood clots and are used to treat extensive deep vein thrombophlebitis and, in some cases, pulmonary embolism.
• Removal of varicose veins. Dilated veins that can cause pain or recurrence of thrombophlebitis are surgically removed.The operation is usually performed on an outpatient basis through small incisions.
  Removal of veins does not affect blood circulation in the legs, since the deeper veins take over the transport of additional blood volume. This procedure can also be performed for cosmetic purposes. After removal of diseased veins, it is recommended to wear compression stockings.
• Kava filter. In some cases, when the use of anticoagulants is not possible, a filter is implanted into the main vein of the abdominal cavity (inferior vena cava) to prevent blood clots from leaving the veins of the legs and moving them to the lungs.Usually the filter is entered permanently.
• Removal of blood clots or shunting. Surgery is sometimes necessary to remove a blood clot that is blocking veins in the pelvis or abdomen.
  To repair a blocked vein, your doctor may recommend surgery to bypass the vein, or a procedure called angioplasty to open the lumen of the vein.
  During the procedure, the doctor inserts special tubes (stents) to keep the vein patent.After surgery, you may need to take blood-thinning medications.

How to treat thrombophlebitis at home →

D-dimer

General information about the study

D-dimer – a protein fragment that is formed as a result of the breakdown of a blood clot. If a vessel or tissue is damaged in the body, the process of blood coagulation is triggered – the formation of blood clots, which include a special protein called fibrin.It “holds” the components of the thrombus together and holds the thrombus where it was formed.

Thrombi can occur not only at the site of tissue or vascular damage, but also inside the vessels in the presence of factors predisposing to this: damage to the inner lining of blood vessels by various endogenous and exogenous substances and antibodies, disturbance of local hemodynamics – stagnation of blood, the presence of turbulent flows. Blood clots in blood vessels are found in a number of diseases: varicose veins of the lower extremities, atrial fibrillation, complicated course of infectious diseases, complications after surgery.During thrombosis, the body triggers mechanisms that contribute to the destruction of blood clots, during their work, fibrin begins to be destroyed by plasminogen and D-dimers are formed. Thus, the amount of D-dimers in the blood indicates the activity of the processes of destruction of thrombi and indirectly allows us to estimate the activity of thrombus formation. Most often, this test is used to diagnose disseminated intravascular coagulation syndrome (DIC), as well as to monitor the therapy of thrombosis with anticoagulants (for example, heparin).

The number of D-dimers can be increased during pregnancy, usually it gradually increases by the third trimester. Until recently, high rates were considered a sign of a threat of thrombotic complications during pregnancy, but recent studies have shown that there is no clear relationship between the level of D-dimer and pregnancy pathology.

The D-dimer assay is used in the vast majority of cases as an auxiliary test, and the diagnosis is made taking into account the clinical picture and the results of other studies.

What is the research used for?

• For the diagnosis of disseminated intravascular coagulation.
• For the diagnosis of deep vein thrombosis.
• For additional assessment of the severity of thrombus formation and monitoring of the ongoing anticoagulant therapy in pulmonary thromboembolism, stroke.

When is the study scheduled?

• For symptoms of deep vein thrombosis:
  • severe pain in the legs (leg),
  • pronounced edema of the legs (legs),
  • pallor of the skin in the area of ​​thrombosis.
• If pulmonary thromboembolism is suspected:
  • sudden onset of shortness of breath,
  • shortness of breath,
  • cough,
  • hemoptysis (blood in sputum),
  • severe chest pain,
  • increased heart rate.