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Deep Vein Thrombosis

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  3. Deep Vein Thrombosis

Overview of Deep Vein Thrombosis

Deep vein thrombosis (DVT) (شریان میں خون کا جم جانا) occurs due to blood clot or thrombus formation in the deep veins of your body. DVT mostly affects the legs and causes pain and swelling. In some cases, it can be asymptomatic.

Occurrence of DVT

Deep vein thrombosis (DVT) occurs with an incidence rate of 1 per 1000 in adult populations per year. Its occurrence rate is slightly higher in men as compared to women. DVT most commonly affects older people.

The incidence of DVT in patients of Asian origin is unknown. As per studies, in Pakistan frequency of DVT occurrence has been recorded 0 to 12.8%.

Signs and Symptoms of Deep Vein Thrombosis

According to the CDC, symptoms of DVT only appear in about half of the affected people. Some common signs and symptoms are:

  • Swelling in your foot, ankle, or leg
  • Cramping pain in the affected area
  • Severe and unexplained pain in foot and ankle
  • Skin becomes warmer than the surroundings
  • The skin over the affected area turning pale 

People having a blood clot in the arm may experience no symptoms. If they do, some common symptoms are:

  • Neck pain
  • Shoulder pain
  • Swelling in the arm or hand
  • Blue-tinted skin colour
  • Weakness in the hand

Types of Deep Vein Thrombosis

Causes of Deep Vein Thrombosis

DVT occurs due to blood clot formation. The clot blocks the vein, preventing proper blood circulation in your body. Clotting can be occurred due to several reasons such as:

  • Injury: Damaged blood vessels have narrowed that block the flow of blood. A blood clot is formed as a result.
  • Surgery: During surgery damage to blood vessels can lead to clot formation. In some other cases, prolonged bed rest after surgery with no movement can also be the reason for clot formation. 
  • Reduced Mobility: Frequent and prolonged sitting leads to blood collection in the legs. It results in thrombus formation in your legs. 
  • Certain Medications: Some medications such as oral contraceptives, thalidomide, and cisplatin can increase the chances of developing a clot.
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Risk Factors of Deep Vein Thrombosis

Many factors can increase the risk of developing deep vein thrombosis (DVT). Some risk factors are:

  • Inherited blood-clotting disorder
  • Prolonged bed rest, such as during a long hospital stay, or paralysis
  • Injury to your veins during surgery can increase the risk of blood clots
  • Pregnant women with an inherited clotting disorder
  • Birth control pills (oral contraceptives or hormone replacement therapy)
  • Being overweight or obese increases the pressure on veins in the legs
  • Smoking (affects circulation)
  • Cancer
  • Heart failure (due to limited heart and lung function)
  • Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
  • A personal or family history of DVT or pulmonary embolism.
  • Age (above 60 years of age)

Health-Related Complications of DVT

A major complication of DVT is pulmonary embolism. A pulmonary embolism develops due to the traveling of a blood clot to your lungs that blocks the vessel.

It can severely damage your lungs and other parts of your body. Signs of pulmonary embolism are:

  • Dizziness
  • Sweating
  • Chest pain that gets worse with coughing
  • Rapid breathing
  • Coughing up blood
  • Rapid heart rate

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Prevention

DVT can be prevented with the help of the following tips:

  1. Engage yourself in physical activity
  2. Do not sit for too long in the same position
  3. Stay hydrated 
  4. Do not wear tight clothes 
  5. Take precautionary measures while travelling 
  6.  Make healthy lifestyle choices
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Diagnosis

Your doctor can help you with the diagnosis of DVT in following ways:

  • Physical Examination: During the physical examination the doctor will check the affected area for swelling, stiffness, and discoloration of the skin. The doctor would also inquire about your symptoms.
  • Blood Test or D-Dimer Test: D-Dimer Test is a blood test that is performed for the diagnosis of DVT patients. D-dimer is a protein that is formed in your blood during clot formation. In this test, the level of D- dimer protein is checked in the patient’s blood. If you have developed severe deep vein thrombosis your D dimer level would be elevated. 
  • Duplex Ultrasonography: Duplex Ultrasonography is an imaging test that is performed to check the detailed image and location of the clot. A wand-like device (transducer) is placed over the affected area of your body. Sound waves from the device travel through the tissues and when reflected back transforms into an image on the computer screen. Sometimes ultrasound is performed repeatedly to check whether a clot is growing or a new one is formed. In Pakistan, this test is available in Aga Khan University Hospital, Laboratories.
  • Venography or Ascending Phlebography: In venography, an X-ray of the vein in your leg or foot is taken to obtain a detailed image of the clot. A dye is injected through a catheter into the blocked vein.
  • CT or MRI scans: These imaging tests (CT and MRI Scans) provide a detailed image of your veins and clot.

Treatment of Deep Vein Thrombosis | When to Consult a Doctor

Deep vein thrombosis (DVT) is treated to prevent the clot from getting bigger and causing a pulmonary embolism. It also decreases the chances of developing deep vein thrombosis recurrence.

Deep vein thrombosis treatment options are:

  • Home Remedies for DVT

If a blood clot is diagnosed, your doctor might prescribe a medication to help to thin the blood. You can combine the prescribed medication with certain home remedies to prevent further complications. These remedies include:

  • Daily Walk: Take daily walks to improve blood circulation. Shorter and frequent walks are better than longer ones.
  • Keep Your Legs Elevated: Use a chair or stool to keep your legs elevated to prevent the pooling of blood. 
  • Wear Compression Stockings: Compression stockings: Compression stockings are worn on affected legs to prevent swelling.

Other Treatment Methods

  • Blood Thinners or Anticoagulants: Most commonly DVT is treated with anticoagulants or blood thinners. These drugs can be injected or taken as pills to prevent clot development. Although, these blood thinners don't break up existing blood clots, but can prevent clots from getting bigger. Heparin is usually injected intravenously. Some other blood thinners, such as enoxaparin or fondaparinux are injected intradermally. You may receive injectable anticoagulants for a few days, after which drugs such as warfarin or dabigatran are started.

  • Clot Busters: Clot busters are drugs that are used to dissolve clots. Your doctor might prescribe these medicines if you develop a more serious type of deep vein thrombosis or pulmonary embolism. If other medicines are not working then also clot busters are prescribed by your doctor. These medicines are either given intravenously or through a catheterization. The catheter is placed directly into your clot. These drugs are only prescribed in severe cases because they cause serious bleeding.

  • Filters: If you are unable to take medicines to thin your blood, a filter is inserted into the large vein (the vena cava) in your abdomen. A vena cava filter prevents the travel of clots to your lungs.

  • Venous Thrombectomy: In some rare cases, the doctor may have to cut the deep vein clot

DVT can lead to pulmonary embolism which is a life-threatening condition. Immediately seek medical help from a certified vascular surgeon if you have signs of a pulmonary embolism.

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