Deep
Vein Thrombosis (DVT) / Thrombophlebitis
Deep
vein thrombosis (DVT) occurs when a blood clot
develops in a vein deep in the body. Deep veins
are found within groups of muscles. The veins
close to the skin are called superficial veins.
While
these clots most often develop in the lower legs
or thighs, they may appear in the upper body,
such as the arms or other locations in the body.
It is estimated that there are more than 2.5 million
persons in the US who develop deep vein thrombosis
each year. Deep vein thrombosis is a risk for
any major surgery, but patients who have surgery
of the legs or hips are at higher risk.
Deep
vein thrombosis can pose a serious threat to health.
Pieces of a clot can break off and travel through
the bloodstream to the lungs. This is called a
pulmonary embolism and can be fatal soon after
it occurs. Deep vein thrombosis can also block
blood flow in the veins, causing the blood to
pool. This can cause swelling, pain, and permanent
damage to the leg called post-thrombolic syndrome.
When
a clot forms in a vein, inflammation of the vein
may occur at the affected site. This is referred
to as thrombophlebitis. Inflammation may be minimal,
or may be more pronounced, causing swelling, redness,
warmth, and tenderness at the site. When thrombophlebitis
occurs, the body's response to inflammation
may promote the formation of more clots.
A risk
factor is anything that may increase a person's
chance of developing a disease. It may be an activity,
diet, family history, or many other things.
Although
these risk factors increase a person's risk,
they do not necessarily cause the disease. Some
people with one or more risk factors never develop
the disease, while others develop disease and
have no known risk factors. Knowing your risk
factors to any disease can help to guide you into
the appropriate actions, including changing behaviors
and being clinically monitored for the disease.
Risk
factors related to or that may contribute to deep
vein thrombosis and thrombophlebitis include,
but are not limited to, the following:
- obesity
- an inherited tendency
that increases risk for blood clots
- age (greater than 60)
- type A blood group
There
are a variety of factors that contribute to the
development of deep vein thrombosis:
- surgery, particularly
surgery of the hip or leg, or abdominal surgery
- a long period of bed
rest or sitting for a long time (e.g., on an
airplane or in a car)
- birth control pills
or hormones taken for symptoms of menopause
- certain diseases and
conditions, such as:
- varicose veins
- chronic atrial
fibrillation
- inflammatory bowel
disease
- lupus erythematosus,
a disease of the immune system
- cancer
- heart failure
- heart attack
- arterial disease
- spinal cord injury
and resulting paralysis
- previous blood clot
(thrombosis)
- pregnancy
- intensive care treatment
involving placement of a central venous catheter
- persons with cancer
receiving chemotherapy
Deep
vein thrombosis occurs without symptoms about
50 percent of the time. When symptoms do occur,
they may include:
- swelling in the leg
- red, discolored, or
white skin
- a cord in a leg vein
that can be felt
- rapid heart beat (tachycardia)
- slight fever
- warm skin
- more visible surface
veins
- dull ache, tightness,
tenderness or pain in the leg (these symptoms
may only occur while walking or standing)
The
symptoms of deep vein thrombosis may resemble
other medical conditions or problems. Always consult
your physician for a diagnosis.
In addition
to a complete medical history and physical examination,
diagnostic procedures for deep vein thrombosis
may include the following:
- duplex ultrasound
- involves using high frequency sound waves
to look at the speed of blood flow, and the
veins. Occasionally a blood clot may be visualized
by ultrasound. This procedure is noninvasive
(the skin is not broken) and involves placing
ultrasound gel on the affected area and then
moving a handheld device across it. A picture
of the blood flow is displayed on a monitor.
Duplex ultrasound is the most commonly performed
diagnostic test for DVT.
- magnetic resonance
imaging (MRI) - a diagnostic procedure that
uses a combination of large magnets, radiofrequencies,
and a computer to produce detailed images of
organs and structures within the body, is particularly
effective in diagnosing deep vein thrombosis
in the pelvis.
- venogram - uses x-rays
and intravenous (IV) contrast dye to visualize
the veins. Contrast dye causes the blood vessels
to appear opaque on the x-ray image, allowing
the physician to visualize the blood vessels
being evaluated.
Specific
treatment will be determined by your physician
based on:
- your age, overall health
and medical history
- extent of the disease
- your signs and symptoms
- your tolerance for
specific medications, procedures, or therapies
- expectations for the
course of the disease
- your opinion or preference
The
goal of treatment is to prevent the clot from
growing, to ensure that it does not break off
and travel through the veins to the lungs, and
to help reduce the possibility of another blood
clot forming.
- medications
Various types of medications may be used in
the treatment of DVT. Although anticoagulants
(blood thinners) do not destroy the clots, they
may keep the clot from growing and other clots
from forming. Warfarin (Coumadin) may be taken
orally or a heparin injection may be given either
intravenously (IV) or under the skin (subcutaneously).
Treatment with blood thinners may last from
three to six months. If a blood clot develops
after surgery, treatment may be shorter. If
there have been previous clots or treatment
for another illness is underway, the treatment
may last as long as risk factors are present.
The most common side effect of blood-thinning
medication is bleeding. Bruising or bleeding
should be reported to the physician right away.
Another type of medication called fibrinolytics
or thrombolytics ("clot busters")
can dissolve a clot quickly, over a period of
a few days. Fibrinolytics are used in certain
situations as determined by a physician.
Thrombin inhibitors are medications that can
disrupt the formation of a clot. Patients who
cannot take heparin may be given one of these
medications.
- vena cava filter
In some cases, a vena cava filter may be inserted
into the vena cava (the large vein which returns
blood from the body to the heart) of patients
who cannot take medication or if blood thinners
are not working. The filter is a kind of "clot
catcher."
Preventing
deep vein thrombosis is important to prevent pulmonary
embolism, which can lead to serious complications.
Medications,
such as anticoagulants or aspirin, may be given
to certain surgical patients to prevent deep vein
thrombosis after the risk of surgical bleeding
has subsided. Those patients who have had a previous
clot should follow the instructions of their physician.
Preventing
deep vein thrombosis caused by long periods of
sitting or reclining involves moving the lower
leg. Flexing (bending) the knees may be helpful.
Other
preventative measures may include:
- getting up and moving
as soon as possible after surgery or illness,
as movement can help to prevent clots from forming
by stimulating blood circulation
- a pneumatic compression
device, which looks like a special fitted sleeve,
placed on the legs to help keep blood moving
during some types of surgery
- elastic stockings to
reduce swelling and promote circulation
Consult
your physician for diagnosis and treatment.
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